How Changes in Payer Policy Could Make a Positive Difference in Treatment Options
Recent press coverage highlights the work of congressional representatives and key opinion leaders to impact insurance carrier policy with respect to nonopioid and abuse deterrent opioid treatment alternatives for pain. Senator Joe Manchin (D-W.Va.) recently sent a letter to the CEOs of UnitedHealth Group and Anthem Inc. asking that they address the barriers imposed on beneficiaries for reimbursement coverage for nonopioid medications and alternative treatment modalities. The letter highlighted the decision of UnitedHealth to withdraw coverage for Butrans®, a buprenorphine alternative to long-acting opioids, and Anthem’s denial of coverage for Lyrica®, in favor of cheaper generic gabapentin. “The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable,” Manchin’s letter stated. “Just as importantly, I urge you to ensure that every beneficiary that you serve that needs substance use disorder treatment, including behavioral health counseling, is able to affordably access it.”
In a related topic, 3 noted pain practitioners, including PAINWeek faculty member Steven Passik, PhD, recently authored an article cautioning against a rush to judgement in evaluating abuse deterrent formulations (ADFs) for opioid analgesics. The authors note that the utilization of ADFs in pain treatment has been slow, this due substantially to payer policies requiring prior authorization and demonstrated failure of non-ADF formulations before they are covered. They write that “It is ironic that epidemiologic data on the effectiveness of ADFs cannot be gathered without sufficient market penetration, but market penetration is impeded by payer policies due to the lack of sufficient data on effectiveness.”
More detail on recent congressional initiatives to impact payor policy may be read here.
Commentary on ADF evaluation and payor coverage may be read here.
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