Attorneys general put insurers on notice for possible role in opioid epidemic; a lawsuit, maybe?

A patient takes hydrocodone.
(NYT photo by Kevin Liles)

Drug companies and doctors have been accused of playing a part in the opioid crisis ravaging America, but insurers may be partly responsible too. Health-insurance plans are more likely to cover opioids that are relatively cheap, while limiting access to more expensive painkillers that carry a lower risk of addiction. That's a problem, because a study by researchers at the University of Arkansas for Medical Sciences found that 20 percent of patients who get a 10-day first-time prescription for opioids will still be using opioids after a year.

"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 the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And 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," Katie Thomas of the Times and Charles Ornstein of ProPublica report. "In contrast, almost every plan covered common opioids and very few required any prior approval. The insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves, the analysis found."

Officials are taking notice. The Department of Health and Human Services is studying whether insurance companies make opioids more accessible than non-opioid painkillers or non-drug therapies (early analyses say yes). And attorneys general from 35 states, the District of Columbia, and Puerto Rico co-signed a letter sent to industry trade and lobbying group America's Health Insurance Plans this week, pressuring insurance companies to take action. "The chief state legal officers are pushing for insurers to review, and potentially revise, payment and coverage policies to encourage health care providers to prioritize non-opioid pain management over opioid drugs for the treatment of chronic pain not caused by cancer," Bill Lucia reports for Route Fifty.

Kentucky's attorney general, Andy Beshear, and his West Virginia counterpart, Patrick Morrisey, held a joint press conference Sept. 18 in Huntington, W.Va., to call attention to the letter. Beth Warren reports for The Courier-Journal that Beshear didn't say what would happen if insurers don't take action, but he referred to lawsuits attorneys general brought against cigarette manufacturers for selling addictive, potentially deadly products; the companies are paying billions in settlements. "Ask the tobacco companies how that works out," Beshear said.

Cathryn Donaldson, a spokeperson for AHIP, told Lucia in an email that insurers are committed to helping solve the problem. "Many health plans have instituted new programs that are helping to dramatically reduce how much—and how often—opioids are prescribed," she said. But the data analysis by the Times and ProPublica found that there are still significant barriers in place for the prescription of less addictive painkillers and addiction treatment drugs such as Suboxone, especially in some state Medicaid programs.