By favoring opioid medications as the cheaper option when compared with safer but more expensive alternatives, insurers may have helped enlarge the opioid crisis.

That’s according to a report by the New York Times and independent journalism organization ProPublica, which says that the New York State attorney general’s office may be taking a closer look at the role insurers and pharmacy benefit managers might be playing in the crisis. Last week the AG’s office sent letters to the three largest pharmacy benefit managers, CVS Caremark, Express Scripts and OptumRx, asking how they were addressing the crisis.

The two news organizations analyzed Medicare prescription drug plans covering 35.7 million people in 2017’s second quarter and found that just a third of covered individuals “had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine.”

However, it adds that “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 addition, nearly all plans covered common opioids, with very few requiring prior approval for them to be prescribed. Also, insurers have placed additional barriers between the approval of addiction treatments than they have in place for the addictive substances those treatments are aimed at.

The report cites an example of a woman being treated with Butrans whose insurer, UnitedHealthcare, stopped covering the drug in January. Butrans had cost UnitedHealthcare $342 for a four-week supply, the report says, while the drug that the patient finally ended up with after an unsuccessful appeal is long-acting morphine.

Not only did UnitedHealthcare not question the morphine prescription, but its cost to the insurer is just $29 for a month’s supply.

UnitedHealthcare has said that the patient has not yet exhausted the appeal process to receive Butrans and that it “will work with her physician to find the best option for her current health status.”

Dr. Thomas R. Frieden, who led the Centers for Disease Control and Prevention under President Obama, is quoted in the report saying that insurance companies, with few exceptions, had “not done what they need to do to address” the opioid epidemic. He adds that at present it’s easier for most patients to get opioids than to receive treatment for addiction.

The Department of Health and Human Services is also looking at whether insurance companies make opioids more accessible than other pain treatments.

Experts studying opioid abuse are also concerned about insurers’ limits on addiction treatments. And the analysis of Medicare plans also found that restrictions are prevalent there as well — either via requirements for prior authorization or prohibitive out-of-pocket costs for the drugs that treat addiction.

Instant Insights /

Insurers may have helped boost opioid crisis: report

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