Dr Thomas Kosten Highlights Payer Oversight of Opioids

Payers have made tremendous progress in improving oversight of opioids and other pain medications, but what is really needed is a shift to abuse-deterrent formulations, which are more expensive, said Thomas Kosten, MD, a psychiatrist with Baylor College of Medicine.

Have payers improved their oversight of opioids and other pain medications? If so, what stategies have been effective?
They've improved their oversight quite substantially and quite effectively. And in many ways, in a way that only an insurance company could do well, which is they've looked at who are the 5 or 6 different doctors that may be prescribing opiates to a single patient without telling each other—that is, the doctors don't know about the others—and the insurance companies simply contact the doctors. And mostly what they get is the doctors say, "I had no idea, and I have no intention of continuing this." So that's an extremely effective strategy, because it limits the outflow and only the insurance company really knows that information, because they are paying for it.

The other things that they've done is, of course, eliminate providers from their networks that when the insurance companies call them up, they tell the insurance company that they have no business interfering in the practice of medicine. Well, it's not the practice of medicine that many of those people are engaged in—they're in the practice of making a lot of money by an illegal activity. And I just wish the insurance companies would do the next step, which is alert the Drug Enforcement Agency, and not just drop them from their panel of providers, because those doctors don't stop prescribing, they just prescribe on the basis of cash only. Which has got plenty of takers.

But, yes, we have made tremendous improvement and the insurance carriers deserve a good amount of credit for that. Unfortunately, the abuse-resistant formulations of opioids, which have been developed, generally cost substantially more than the nonabuse-resistant. And there has been some real pushback from a variety of sources, the insurers being one of them about paying for that, which is unfortunate, because tamper-resistant, abuse-resistant, we've got plenty of evidence that that works very well to decrease the abuse of that specific drug. And there are, of course, dozens of opiates, and they would all have to have some type of intervention of this sort so that all the abusers wouldn't simply target the ones that don't have these.

But right now, to have the financial factor dictating that we'll use the cheapest stuff, which is the most abusable, isn't good.
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