“The insurance industry appears to have played a major role in the development of a new strategy by the federal government to combat the abuse of opioid pain medication,” writes Pat Anson, editor of Pain News Network. This Orwellian act by powerful insurance companies in collaboration with the US Department of Health and Human Services (HHS) proposes to deputize pharmacists “to report suspicious activity by doctors who prescribe opioids to Medicare and Medicaid patients (see ‘Medicare Takes ‘Big Brother’ Approach to Opioid Abuse’). Individual profiles of patients, their behavior, and opioid use would also be created and shared among insurance providers.”
Healthcare Fraud Prevention Partnership Creates White Paper
The Healthcare Fraud Prevention Partnership (HFPP) laid the groundwork for this plan by creating a “white paper” called “Healthcare Payer Strategies to Reduce the Harms of Opioids.” According to its website, “The Healthcare Fraud Prevention Partnership (HFPP) is a voluntary public-private partnership between the federal government, state agencies, law enforcement, private health insurance plans, and healthcare anti-fraud associations. The HFPP aims to foster a proactive approach to detect and prevent healthcare fraud through data and information sharing.”
According to Anson, “The white paper was drafted largely by insurance companies – called ‘Partner Champions’ – including Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation.” He further explains that the white paper “goes far beyond fraud prevention by recommending policies that will determine how a patient is treated by their doctor, including what medications should be prescribed. It states that all physicians should follow the opioid prescribing guidelines released by the Centers for Disease Control and Prevention, even though the guidelines are voluntary and explicitly state they are not intended for all prescribers.” Furthermore, the CDC guidelines are based on very limited science.
Insurance Companies Set Reduced Targets for Opioid Prescribing
Most of the major private insurance companies have set reduced prescribing targets for opioids. For example, “Cigna aims to reduce the number of opioid prescriptions written to its customers by 25%, back to the number of prescriptions that were being written in 2006, which the insurer calls “pre-crisis.”
Most people agree there are far more opioids prescribed than necessary and this has contributed to the opioid crisis. However, the problem is less about the amount of opioids prescribed than how they have been used. Setting an arbitrary goal of opioid prescribing reduction without ensuring those who need the medication continue to receive it at appropriate doses can have serious harmful consequences.
Insurance Must Mandate Coverage for Alternative Pain Therapies
HFPP is using the CDC opioid prescribing guidelines as a way to limit coverage for opioids, but without providing coverage for the alternative therapies that are also part of the CDC recommendation. If the guidelines are mandated by insurance companies, it would seem that insurance should also mandate coverage for alternative therapies.
Asking pharmacists to determine the appropriate opioid prescribing to patients will likely lead to an adversarial relationship between prescribing providers and pharmacists. This will compromise medical care for patients, not strengthen it. Should pharmacists also report when patients are denied access to appropriate opioid medications? Why not?
It is understandable that industry and policymakers want to curb the opioid problem. However, there must be compassion to improve the care of all patients, including those with pain.
Prescribing providers and pharmacists must have a collaborative relationship for the benefit of all patients. We need to allow compassion to lead us forward but allow science to light the way™.
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Copyright 2017, Lynn Webster, MD