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Insurance Companies Enter the War on Drugs


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The opioid crisis has been grabbing headlines for years as overdoses skyrocket and the victims become move diverse (suburban teens, professionals, otherwise law-abiding citizens). Blame constantly shifts from lawmakers to doctors to pharmacists to manufacturers and to users. The starting point is usually aimed at Purdue Pharmaceuticals who pushed to have pain be the “fifth vital sign” for doctors to better understand a patient’s state. And when pain was present, Purdue had the perfect remedy – the new “non-addictive” painkiller, Oxycontin, a time-release version of the opioid oxycodone. Their reasoning behind the non addictiveness was because the drug was released slowly over a period of time, which would deter recreational users while managing the pain of legitimate patients.

Purdue has been fighting lawsuits since 2007 when the company paid $600 million in damages for misbranding the drug and misleading doctors, regulators, and patients. Although the company reformulated Oxycontin to make it less abusable in 2010, it was too little too late because lawsuits continued to plague Purdue. In 2015 the state of Kentucky settled with Purdue for $24 million, and that is one of many, including Texas who sued this past May. Despite the staggering fines the company has paid in the past, it is only a small dent considering they have reported over $35 billion in revenue.

Now private insurers have joined the fight by refusing to reimburse for Oxycontin. “Cigna grabbed headlines last fall when it announced it was dropping coverage of OxyContin from its list of preferred medications for employer-sponsored health plans beginning this year. About 1 million Texans have such plans.” Three years ago United Health Care stopped covering Oxycontin for employee-sponsored health plans of which around 3 million Texans have. Luckily, patients who are already treated with the drug will be grandfathered in and continue to utilize their coverage. Blue Cross Blue Shield will take a lighter approach by instituting safeguards to curtail abuse such as scrutinizing the quantity and dosage, and check for different doctors writing a similar prescription for the medication.

“Community Health Choice, a Houston-based health insurer, will also continue to cover OxyContin but will restrict the number of pills prescribed and will monitor multiple prescriptions to the same patient as well as tracking doctors who appear to be over-prescribing, said Dr. Karen Hill, senior vice president of medical affairs for the insurance company.” While Dr. Hill questions the effectiveness of the change, Dr. Brian Bruel, associate professor of physical medicine and rehabilitation at Baylor College of Medicine, comments: “This, to me, is (insurers) practicing medicine.”

Professionals cannot reach an agreement on how to tackle such a complicated issue. “Katharine Neill Harris, a fellow in Drug Policy at Rice University’s Baker Institute of Public Policy, has mixed feelings about insurers’ entrance into the fray. Doctors need the discretion to recommend pain medication they already know is working for their patients.” She, like many others, would prefer doctors to explore other remedies such as physical therapy.

If you’re already taking Oxycontin, you have little to worry about as far as being cut off. If your insurance refuses to cover the drug, Xtampza ER (oxycodone) or Morphabond (morphine sulfate) can easily take its place. If you or a loved one have suffered from anguish due to unnecessary use of Oxycontin, contact Reich and Binstock today.



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