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Health insurance policies steer patients to older, more addictive opioid drugs, study suggests

Lawsuits filed on behalf of opioid patients who suffered an overdose have focused attention on the role that drug companies and doctors have played in the U.S. opioid epidemic. But state and federal officials have started turning their attention to another group that has contributed to the opioid crisis – health insurance companies.

According to an investigation published by the New York Times and Pro Publica, many insurance companies are charging patients more for opioid medications designed to lower the risk of addiction and dependency, while charging patients less for older painkillers that carry a higher risk of abuse. As a result, it has become more difficult for patients who need chronic pain medication to take medications that could prevent them from becoming addicted and help lower their risk of a deadly overdose.

The New York Times and Pro Publica found that out of the 35.7 million people in the U.S. with Medicare prescription drug benefits, only about one-third had access to Butrans – a painkiller patch that contains the opioid buprenorphine – which carries a lower risk of addiction. They also found that every health plan that covered lidocaine patches, which are non-addictive, required prior authorization from a doctor before they could be dispensed.

Nearly every one of the health plans analyzed by the New York Times and Pro Publica covered generic opioid painkillers such as hydrocodone. None of these medications required prior authorization from a doctor.

The investigation also compared how specific drugs – with different potentials for abuse – were handled differently by health insurers. Investigators found that while United Healthcare – the largest health insurance company in the U.S. – places few cost or approval restrictions on morphine (which the DEA says carries a high potential for abuse), it excludes most patients from taking Butrans (which the agency says is less likely to cause abuse or dependency). United Healthcare also requires patients to try other painkillers before they use Lyrica, a non-opioid drug used to treat nerve pain, making it more difficult to use this drug than other more addictive opioids.

Role of Health Insurance Companies in U.S. Opioid Crisis

Health insurance companies have been reluctant to cover abuse-resistant opioid medications because they are more expensive than older generic opioids. But as a result of this effort to reduce costs, experts believe that insurance companies may be passing along risks to their customers in the form of an increased danger of addiction and other serious health consequences of opioid use.

According to data from the CDC, 20% of patients who receive a 10-day supply of opioid medications will still be using these drugs one year later. As a result, patients who are prescribed only a small amount of drugs such as hydrocodone, morphine, oxycodone, methadone, or hydromorphone by their doctors may end up becoming dependent on these medications.

Many patients say that even though they want to take pain medications with a lower risk of addiction or other complications, they are unable to switch because they are prevented from doing so by insurance company policies. Even for some patients who have shown a previous problem with opioid abuse, they are unable to switch to non-opioid or less addictive medications because the prescription drug benefits on their insurance policy won’t cover the medications. Patients say that in order to switch, their insurance company requires them to go through a lengthy approval process, which many find too arduous, causing them to go back to generic opioids with a greater risk of complications.

The role that insurance companies have played in the U.S. opioid epidemic has begun to draw attention from officials trying to deal with the problem of opioid abuse and addiction. Recently, the attorney general of New York sent a letter to CVS Caremark, Express Scripts, and OptumRx – three pharmacy benefit managers that help decide what drugs are covered by insurance – to inquire what these companies are doing to combat the opioid crisis.

According to Dr. Thomas R. Frieden, the head of the CDC under President Obama, insurance companies have “not done what they need to do to address” the U.S. opioid epidemic. Dr. Frieden says that in most cases, it easier for patients to obtain opioid medications than it is for them to get treatment for addiction and dependency caused by these drugs.

Northeastern University law professor Leo Beletsky says that health insurance companies have been “one of the major causes of the crisis.” Beletsky says that because insurance companies are more willing to pay for older, more addictive generic opioids than safer non-opioid and addiction-resistant painkillers, they incentivize doctors to prescribe these medications, increasing their patients’ risk of addiction, dependence, and overdose.

Opioid Overdose Lawsuits Filed by Heygood, Orr & Pearson

If you have lost a loved one to an overdose caused by opioid painkillers, you may be eligible to file a lawsuit against the manufacturer of the drug, the doctor who prescribed the medications, or other responsible parties. For more information about filing an opioid lawsuit and to find out if you qualify to file a case, contact the lawyers at Heygood, Orr & Pearson to receive a free legal consultation.

Heygood, Orr & Pearson has filed lawsuits on behalf of hundreds of patients who were injured by dangerous drugs, including opioid painkillers. Our law firm has filed more lawsuits on behalf of patients who were hurt by the fentanyl pain patch than all other firms in the country combined. Heygood, Orr & Pearson has also filed cases on behalf of patients who were injured by other opioid medications.

For more information and to speak with an attorney about your case, contact Heygood, Orr & Pearson by calling toll-free at 1-877-446-9001. You can also reach us by following the link to our free case evaluation form and answering a few short questions about your case to get started.

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