Safer Alternatives to Opioids

In the process of reading many articles about the Opioid Epidemic, the thought occurred to me, "Gee, I wish they would come up with some more effective, safer alternatives to the opioids for controlling pain."  As it turns out, they actually have.  But they are often more difficult for patients to access than the cheaper opioids which are more likely to be covered by insurance. This eye-opening article was linked on Facebook by my cousin, who is a physician whose specialty is pain management: https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html?smid=fb-share
More after the break:


From the article: "ProPublica and The New York Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them.
...In contrast, almost every plan covered common opioids and very few required any prior approval.

....The Drug Enforcement Administration places morphine in a higher category than Butrans for risk of abuse and dependence. Addiction experts say that buprenorphine also carries a lower risk of overdose.

...UnitedHealthcare, the nation’s largest health insurer, places morphine on its lowest-cost drug coverage tier with no prior permission required, while in many cases excluding Butrans. And it places Lyrica, a non-opioid, brand-name drug that treats nerve pain, on its most expensive tier, requiring patients to try other drugs first.

...Several patients said in interviews that they were terrified of becoming dependent on opioid medications and were unwilling to take them, despite their pain.

.....In 2009, Amanda Jantzi weaned herself off opioids by switching to the more expensive Lyrica to treat the pain associated with interstitial cystitis, a chronic bladder condition.

But earlier this year, Ms. Jantzi, who is 33 and lives in Virginia, switched jobs and got a new insurer — Anthem — which said it would not cover Lyrica because there was not sufficient evidence to prove that it worked for interstitial cystitis. Ms. Jantzi’s appeal was denied. She cannot afford the roughly $520 monthly retail price of Lyrica, she said, so she takes generic gabapentin, a related, cheaper drug. She said it does not manage the pain as well as Lyrica, which she took for eight years." 

What we are really talking about here is healthcare rationing.  I don't think it is a matter of public option vs. private insurance, because Medicaid and Medicare do it also.  No one expects insurance to cover unproven treatments, and unfortunately rationing in some form will always be with us. But is it too much to ask that it be done smarter, and with the welfare of the patient as the top priority?