Insurance rules make it more difficult to treat disorders related to opioid use

The cost control measures of the insurance industry could worsen the epidemic of opioids in the country by limiting access to a key drug to treat addiction, according to a research letter published today in the Journal of the American Medical Association.

Despite increasing acceptance by the medical profession of the need for addiction drugs that provide hope for people with opioid use disorder, a study conducted by OHSU clinician scientists in Portland , Oregon, revealed that insurance rules were increasingly limiting the use of Medicare beneficiaries between 2007 and 2018.

"Buprenorphine is a safe and effective treatment that reduces the number of deaths from opioids and prevents the use of heroin and other opioids." People who take buprenorphine are able to rebuild their life, "said co-author Todd Korthuis, MD, MPH, Professor of Medicine (General Internal Medicine and Geriatric Medicine) and Public Health and Preventive Medicine at the OHSU School of Medicine. "Medicare companies are making it increasingly difficult to prescribe buprenorphine, while facilitating the prescription of opioid badgesic medications that have contributed to the opioid epidemic."

Researchers from the OHSU and the OHSU / Oregon State University Pharmacy College badyzed the publicly available form files held by the Medicare Part D prescription drug program. They focused on badessment of the pre-approval rate as it is a practice commonly used by insurance companies to manage or limit access to certain drugs.

"Pre-authorization policies are commonly used to control costs or manage the use of the pharmacy, but they can also disrupt or delay the treatment of people who are vulnerable to relapse," he said. Lead author, Daniel Hartung, Pharm.D., MPH, Associate Professor at OHSU. / OSU College of Pharmacy. "Access to buprenorphine is vital as part of the Medicare program because Medicare has not covered methadone, which is the other opioid agonist indicated for use disorder. opioids. "

In the case of buprenorphine, researchers found that the proportion of insurance plans offering unrestricted buprenorphine fell from 89% in 2007 to 35% in 2018. In comparison, they found that access to opioids that fed the epidemic was relatively easy: from 93% to 100%. percentage of diets covered prescription opioids without any restrictions.

"The reasons for the restrictions on buprenorphine may reflect a misperception of drug risk, social norms related to the stigmatization of addiction, or financial considerations," write the authors.

Buprenorphine, approved by the Food and Drug Administration in 2002, relieves withdrawal symptoms and pain, and normalizes brain function by acting on the same brain targets as prescription opioids or heroin. It is one of three FDA-approved drugs for the treatment of opioid addiction, along with methadone and naltrexone.

The insurance coverage for buprenorphine appears to be diminishing just as the drug treatment of opioid use disorder is becoming more and more embraced by the medical profession. The US Addiction and Mental Health Services Administration recommends the use of drugs such as buprenorphine as an effective response to opioid use disorder.

In September, Oregon adopted a rule preventing drug treatment providers from refusing to treat people taking buprenorphine or other drug-badisted therapies.

"Many people still believe that the drug treatment does not really recover," Korthuis said. "There is overwhelming scientific evidence that drugs such as buprenorphine are far more successful and safer than abstinence-only approaches Buprenorphine saves lives." do not do it. "

Provided by
University of Health and Sciences of Oregon