The largest insurer in Tennessee has introduced it would not cowl prescriptions for what was as soon as a blockbuster ache reliever. It’s the most recent insurance coverage firm to show in opposition to OxyContin, whose maker, Purdue Pharma, faces dozens of lawsuits associated to its high-pressure gross sales techniques across the nation and contribution to the opioid disaster. Last fall, Cigna and Florida Blue each dropped protection of the drug.
Top officers at BlueCross BlueDefend of Tennessee say newer abuse-deterrent opioids work higher, and beginning in January, the insurer masking three.four million Tennesseans can pay for these opioids made by different pharmaceutical firms as a substitute.
“We felt it was time to move to those products and remove Oxycontin from the formulary, which does still continue to have a higher street value,” stated Natalie Tate, the insurer’s vp of pharmacy.
OxyContin was reformulated in 2010 to make the drug tougher to misuse — however it’s nonetheless doable to crush or liquefy with a view to snort or inject it.
The newest long-acting opioids that BlueCross BlueDefend of Tennessee goes to start out masking — Xtampza and Morphabond — are nonetheless harder to misuse, in response to the corporate and a few pharmaceutical consultants.
In a page-long response a reporter’s question, a Purdue Pharma spokesman identified that no opioid drug is “abuse proof” or much less addictive, accusing BCBST of monetary motives that take away selections for a lot of sufferers.
“We believe that patients should have access to FDA-approved products with abuse-deterrent properties,” Purdue’s Robert Josephson wrote in an electronic mail. “The recent decision by BlueCross BlueShield of Tennessee limits prescribers’ options to help address the opioid crisis.”
In response, BCBST’s Tate argued that ditching one of the crucial acknowledged names in opioids just isn’t designed to save cash, although it might in a roundabout means.
This transfer might cut back fraudulent prescriptions to avenue sellers or drug-seeking individuals with energetic addictions and lower down on pricey hospital stays for overdoses, stated ache marketing consultant and pharmacist Jeff Fudin, an adjunct professor at Albany College in New York.
“It’s a smart idea to use dosage forms that have proven to have been better abuse-deterrent formulations,” he stated. “In the long run, it actually will cost them a whole lot less money.”
Fudin stated he’s usually at odds with insurers over their choices about which medication to cowl, however he applauds this resolution, which he expects extra insurers to comply with.
Subscribe to KHN’s free Morning Briefing.
Practicing ache physicians in Tennessee — who repeatedly battle with insurance coverage firms — additionally approve of the change, although they stated OxyContin was already falling out of favor. And they argue buying and selling one opioid for barely safer ones doesn’t tackle a bigger gripe that physicians have with insurers over paying for different, non-addictive kinds of remedy.
“We will have denials and prior authorizations on a muscle relaxer, and we will have no issue getting an opioid through the insurance company,” stated Dr. Stephanie Vanterpool, an anesthesiologist on the University of Tennessee and the president-elect of the Tennessee Pain Society.
“The physicians or the doctor’s offices jump through hoops to get the better medication for the patients,” stated Vanterpool. “And when I say better medication, I mean the medication that’s treating the cause of the pain, not just the medication that’s covering up the pain.”
BlueCross BlueDefend of Tennessee is including some different ache therapies within the coming yr, in response to its announcement last week. But Vanterpool want to see a philosophical about-face.
Not to say OxyContin received’t be sorely missed by some sufferers.
“There are plenty of people who benefit from that drug,” stated Terri Lewis, a affected person advocate and rehabilitation specialist from Cookeville, Tenn.
She’s suspicious of BCBST’s motives because the insurer could also be blamed for its position within the opioid disaster. Embattled Purdue Pharma may very well be a handy scapegoat.
“Maybe this is a good decision,” Lewis stated. “But it smells like a political decision.”
And this might be simply the most recent resolution inserting politics right into a nuanced medical downside.
A Blessing In Disguise?
The Tennessee legislature instituted a number of the tightest opioid prescribing regulations in the country this yr — a three-day restrict for most individuals who aren’t already on opioids. And even long-term ache sufferers are having bother getting refills.
John Venable of Kingsport, Tenn., was proven the door by his ache clinic in July after greater than a decade on oxycodone — a generic, short-acting model of OxyContin.
“I just felt like I was in a hopeless state, like, ‘there is no help for John,’” he recalled.
At their worst, he stated his complications get so debilitating “that death would be a relief.” Despite his dread, he’s seen one thing shocking over the previous couple of months with out opioids — his crippling complications haven’t gotten that a lot worse, if in any respect.
“It very well might be a blessing in disguise,” Venable stated.
The retired builder and one-time pastor stated he prays that these dropping OxyContin additionally will get to make use of the second as a possibility, although he is aware of many can’t lower ties with opioids. And he worries some will flip to extra harmful medication off the road and even ponder ending their very own lives.
Experts level out that the variety of opioid prescriptions has already been falling across the nation. And in Tennessee, BCBS has skilled a 26 p.c drop in opioid prescription claims over three years.
But limiting authorized entry to opioids hasn’t turned again the rise in overdose deaths, which hit a record in Tennessee and nationwide final yr.
KHN’s protection of prescription drug improvement, prices and pricing is supported partly by the Laura and John Arnold Foundation.
Blake Farmer, Nashville Public Radio: firstname.lastname@example.org”>email@example.com, @flakebarmer