At a time when the U.S. is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications. The reason is that opioid drugs are generally cheap while safer alternatives are often more expensive, report the New York Times and ProPublica. Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years. The role that insurers and pharmacy benefit managers that run drug plans have played in the opioid crisis has received less attention. That may be changing.
The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis. ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of those covered had access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. Every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them. In contrast, almost every plan covered common opioids and very few required any prior approval. Insurers have erected more hurdles to approving addiction treatments than for the addictive substances themselves. Dr. Thomas Frieden, who led the Centers for Disease Control and Prevention under President Obama, said that insurance companies, with few exceptions, had “not done what they need to do to address” the opioid epidemic. Right now, he noted, it is easier for most patients to get opioids than treatment for addiction.