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Are PBMs Fueling the Opioid Crisis?

Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers and PBMs have played a role, too.

“At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.” So begins a fascinating article by Katie Thompson, which was co-published by The New York Times and ProPublica, a nonprofit news outlet.

The article, which quickly went viral, comes just as the New York Attorney General, Eric Schneiderman’s office has sent letters to the three largest pharmacy benefit managers – CVS Caremark, Express Scripts and Optum Rx – asking how they are addressing the crisis. According to the CDC, 20% of patients who receive an initial 10-day prescription of opioids will still be on them in a year.

ProPublica analyzed Medicare prescription drug plans and found that only one third of people covered have access to Butrans, a painkilling skin patch that contains a less-risky opioid. Moreover, every plan that covered non-addictive lidocaine patches required prior approval. (United HealthCare the nation’s largest health insurer, places morphine on its lowest-cost drug tier with no prior permission required.)

Analysis by the Department of Health and Human Services suggests that insurance companies and PBMs are placing fewer restrictions on opioids than on less addictive, non-opioid medications and non-drug treatments like physical therapy. Indeed, it is often easier for most patients to get opioids than it is for them to get treatment for addiction!


Read the rest of Katie Thomas’ (deservedly) much-shared article: 


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