Dr. Webster and I wrote an article in 2015 about an insurance company’s reluctance to pay for abuse-deterrent formulations of opioids. We continue to opine that insurers would rather see patients with chronic pain, who were expensive to maintain, overdose and die rather than have to pay for continued treatment of pain with more expensive abuse-deterrent formulations and, of course, the cost of all the comorbidities associated with chronic pain. ADFs are not addiction-deterrent, they are abuse-deterrent; mortality will always be associated to some degree, but these medications, in methodologically robust studies, have shown huge decreases once abuse-deterrent formulations have come into the picture. The good news is that certain insurers are covering and have become progressively more willing to pay for ADFs. A certain oxycodone extended-release product replaced OxyContin on one big insurance company’s formulary. Since that happened, we’re using the newer product, which is harder to crack into than Fort Knox and has got stronger abuse-deterrent qualities.
How should the clinician proceed right now? From a perspective of advocacy, when they prescribe an abuse-deterrent formulation and an insurer says “No, we’re not going to pay for it,” they need to advocate for their patients because I think they know the benefits of abuse-deterrent formulations over generic medications. People with chronic pain are a marginalized, stigmatized, and oftentimes brutalized population, and not giving them access to the safer medication is almost genocidal.