The OHSU study finds it easy to get opioids, but it is increasingly difficult to get medical attention when it comes to treating opioid dependence.
According to a study published in Journal of the American Medical Associationcost control measures in the insurance sector may worsen the opiates epidemic in America by restricting access to key medicines, so treatment of opioid dependence may be more difficult than necessary.
Insurance rules make it difficult to treat opioid dependence
Despite the increasing acceptance by the medical profession of the need for addictive drugs that give hope to opiate users, according to the OHSU, the United States, insurance rules increasingly limit the use of of buprenorphine among Medicare 2007 and 2018 beneficiaries.
Todd Korthuis, M.D., M.P.H., Professor of Medicine and Public Health and Preventive Medicine at the OHSU School of Medicine, explains: "Buprenorphine is a safe and effective treatment that reduces opiate deaths and stops the use of heroin and other opiates.
"People with buprenorphine can get their lives back.
"Medicare insurance companies are making it increasingly difficult to prescribe buprenorphine, while making it easier to prescribe opioid pain medications that have contributed to the opioid epidemic."
Details of the study
Researchers analyzed publicly available form files supported by the Medicare Part D drug plan. They focused on examining the level of pre-authorization requirements as this is a common practice that insurance companies use to manage or restrict access to certain medicines.
Daniel Hartung, an associate professor at the OHSU / OSU Pharmaceutical College, explains: "Prior authorization policies are typically used to control the cost or use of the pharmacy, but they can also disrupt or delay the treatment of individuals who are vulnerable to relapse"
"Access to buprenorphine is vital in the Medicare program because Medicare did not cover historical methadone, the other opioid agonist identified as opioid abuse."
Regarding buprenorphine, the researchers found that the percentage of unconstrained buprenorphine insurance plans declined from 89% in 2007 to 35% in 2018. By comparison, they found that access to opioids that fed the epidemic , is relatively easy: 93% to 100% of opioid-free prescription plans.
Why are there restrictions then?
"Reasons for restrictions on buprenorphine may reflect inaccurate perceptions about drug risk, social norms related to the stigma of addiction or financial considerations," the authors write.
Approved by the Food and Drug Administration in 2002, buprenorphine relieves withdrawal symptoms and pain, and normalizes brain function by acting on the same brain targets as prescribed opioids or heroin.
It is one of the three drugs approved by the FDA to treat opioid dependence, along with methadone and naltrexone.
The buprenorphine insurance coverage seems to be diminishing at the very moment when the drug treatment of the opiate use disorder becomes more and more widely accepted in the medical profession.
Drugs Against Drugs
The United States Drug and Mental Health Administration recommends the use of drugs such as buprenorphine as an effective response to the opioid crisis.
In September, Oregon adopted a rule that does not allow addiction treatment providers to refuse treatment for people who are taking buprenorphine or other medication therapies.
"Many people still believe that medication treatment is not really a recovery," concluded Cortius.
"The prevailing scientific evidence supports the fact that drugs such as buprenorphine are far more successful and safer than abstinence-only approaches. Buprenorphine saves life. Approaches based on abstinence are not. "