I blogged that President Barack Obama has requested that Congress earmark $1.1 billion to combat the U.S. opioid, and the fact that I support the president on that.
Yet the president made no mention the need to help people in pain. The CDC and Johns Hopkins issued opioid prescribing guidelines without out a peep of concern for the vast majority of people in persistent pain who could be harmed by the guidelines. This is where the national dialogue about opioid addiction is now.
Payers deny alternative therapies and limit treatment options to opioids. And then, if the opioid is used off label, they want to sue to recover cost.
There is no law, or moral or ethical principle, that prevents physicians from prescribing off label. In fact, anti-opioid advocates have been using that argument to insist that the FDA must limit indication for opioids to only cancer or acute pain, stating that physicians can always prescribe off label.
Well, sure. It’s true. Physicians can prescribe off label, but that doesn’t mean an insurance company will pay for the drug or prevent a plaintiff’s attorney from accusing a doctor of wrongdoing because he/she was not prescribing on label.
Here’s an example of what can happen if a physician prescribes a painkiller off label.
A colleague recently told me that a patient of hers had received IV fentanyl, and she shared that the treatment had led to lawsuit. Humana, an insurer, is suing a pharmacy for dispensing IV fentanyl for pain control to a 28-year-old woman who had a rare mitochondrial diagnosis. She had such intense pain that she was suicidal.
Because the patient did not have a diagnosis of cancer to support the use of the painkiller and coverage under the Medicare Part D plan, Humana wants to recover hundreds of thousands of dollars.
The patient is deceased, but what really caused her death was the pain she could not bear. The painkiller may have eased her suffering, and in that sense, it was appropriate to give it to her.
But Humana disagrees. Humana’s opinion is that, because the opioid was prescribed off label, her insurer shouldn’t have to pay for it.
That is inhumane, and it is greed.
The anti-opioid groups accuse Pharma of greed which, they say, has fueled the current opioid crisis. They’re partly correct. Pharma has been guilty of making opioids widely available.
But that’s not the whole story.
What is missing from the discussion is the greed and immoral behaviors of insurance companies such as Humana, but it isn’t only Humana. Payers are as much responsible for our current opioid crisis as anyone, or any other group. And our government is letting them off the hook.
Michele says
February 23, 2016 at 11:56 amIf you are not in horrific pain one cannot imagine what a patient who is goes through. These are people who come from all walks of life and are an integral part of our society. People do have pain of cancer and sometimes worse. Why torture them? My daughter has most of her intestine out and other diseases beside crohns. She is like an angel to all that know her and will become one if doesn’t have Meds to help her horrific pain. With meds she can move and be human. Without these, she withers in pain. Millions like her. Please think as a humanitarian not as a Middle Ages torturer.