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Health Insurers May Be Contributing to the Opioid Crisis in the United States

Posted  September 18, 2017

By the C|C Whistleblower Lawyer Team

An article in the New York Times describes the role health insurers may be playing in perpetuating the opioid crisis in the United States. The argument is that health insurers are limiting access to pain medications that have a lower risk of dependency. The reason is that opioid drugs are generally cheaper and less risky alternatives are more expensive. The New York State Attorney General sent letters to CVS, Express Scripts, and OptumRx, the country’s three largest pharmacy benefit managers, to ask how each was addressing the opioid crisis.

An analysis done by the New York Times in conjunction with ProPublica revealed that of 35.7 million Medicare prescription drug plans analyzed in the second quarter of 2017, only one-third of the people covered had access to Butrans an opioid alternative that carries less chance of dependency. While almost every plan covered common opioids with little to no prior approval. The analysis also revealed that insurers have created more hurdles in gaining approval for addiction treatments than for the addictive drugs themselves.

Some insurers like UnitedHealthcare place morphine on the lowest cost coverage tier while excluding Butrans and placing other non-opioid drugs like Lyrica on its most expensive tier, which forces patients to try other drugs first. Dr. Thomas R. Frieden, the former leader of the Center for Disease Control and Prevention under former President Obama believes that insurance companies have not done what needs to be done to address the opioid crisis with few exceptions. He reiterated the point that in many cases it is easier to get opioids than treatment for addiction.

While the reality is that the majority of the opioid crisis is centered on the use of heroin and fentanyl, addiction from prescription drugs is still a problem and a threat. According to a recent analysis by the CDC, 20% of patients who receive a ten day prescription for opioids are still using the drugs after a year. In order to tackle the opioid crisis head on, insurers, pharmaceutical companies, and government entities need to work with the public to clearly explain the dangers of prescription opioids and aid the public in finding non-opioid alternatives.

Tagged in: Healthcare Fraud, Pharma Fraud,