Showcasing yet another downside of the nation's for-profit system, a new report by ProPublica and the New York Times reveals that despite the U.S. opioid crisis, many insurance companies provide easy access to highly addictive opioid medications for pain relief while restricting access to less-risky but more costly alternatives.
As the nation's opioid epidemic has grown, "drugmakers, pharmaceutical distributors, pharmacies, and doctors have come under intense scrutiny in recent years, but the role that insurers—and the pharmacy benefit managers that run their drug plans—have played in the opioid crisis has received less attention," note the Times' Katie Thomas and ProPublica's Charles Ornstein.
The pair spoke with patients who have struggled to access pain relief medications through insurance providers such as Anthem and UnitedHealthcare, the nation's largest insurer. They also analyzed Medicare prescription drug plans that covered 35.7 million Americans and found only a third of those with coverage could access "a painkilling skin patch that contains a less-risky opioid," whereas nearly all plans covered "common opioids, and very few required any prior approval." Further, they found that "insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves."
And although addiction experts have observed that as this epidemic evolves, "the problem now appears to be rooted more in the illicit trade of heroin and fentanyl," the reporters also note a recent Centers for Disease Control and Prevention analysis showing that "risks for chronic use" increase "with each additional day" an opioid is prescribed, and of those patients who receive initial 10-day prescriptions, 20 percent will continue using the drugs after one year.
The ProPublica/Times report provoked an outpouring of personal anecdotes that often mirrored those featured in the article, and strong condemnation of insurance companies, as well as doctors and the pharmaceutical industry.
I was sent home after a catastrophic paralysis w/a bag of morphine pills. They did not control the pain. Your story reflects my experience.
— Victoria Brownworth (@VABVOX) September 18, 2017
Could the Opioid Crisis be fueled by pharma profiteers and health insurance oligarchs https://t.co/8HPg0KnhH5
— Philly DSA (@PhillyDSA) September 18, 2017
Capitalist horror: insurers push more-addictive opioids when less-addictive drugs are available. Profit first: https://t.co/1Gy2Etu7zH
— Richard D. Wolff (@profwolff) September 18, 2017
It also spurred calls for reform—to prescription practices and drug costs, but also to healthcare more broadly.
Our health insurance system presses health care providers to quickly treat symptoms, not root causes. Key reason why opioids overprescribed https://t.co/101mCff9rJ
— Leo Beletsky (@LeoBeletsky) September 18, 2017
The price of drugs is a huge part of the American opioid crisis. / https://t.co/SwRvP8xJHo
— Daniel Skinner (@danielrskinner) September 17, 2017
In case you didn't know, the opioid epidemic is fueled in part by systemic failures in health care: https://t.co/hU4EECsZgT
— Jose A. DelReal (@jdelreal) September 18, 2017
Eye-opening. We could have more control over an issue like this with single payer health care. https://t.co/m8FXIdup8C
— Sandra Hutchison (@SheerHubris) September 17, 2017
This report comes less than a week after Sen. Bernie Sanders (I-Vt.), with substantial support from Senate Democrats, introduced a bill aimed at reforming how Americans access health insurance and healthcare. Sanders' Medicare for All bill proposes transitioning from the U.S.'s for-profit healthcare system toward a national single-payer program that guarantees care for all Americans.
In an op-ed for the Boston Globe last week, Sen. Elizabeth Warren (D-Mass.) wrote of the opioid crisis: "I believe we can beat this epidemic," while also noting that overcoming the nationwide opioid crisis requires coordination and investment at all levels. Warren—who is co-sponsoring Sanders' healthcare bill— added:
Healthcare and social workers, counselors, and law enforcement agencies, and policy makers and administrators at the local, state, and federal levels of government are already putting it all on the line to help people overcome addiction. We must give them with the tools and support they need so we can win this fight.