Bloodwork was imagined to be the final step in Isela’s software for all times insurance coverage. But when she arrived on the lab, her appointment had been canceled.
“That was my first warning,” Isela mentioned. She contacted her insurance coverage agent and was informed her software was denied as a result of one thing on her treatment checklist indicated that Isela makes use of medication. Isela, a registered nurse who works in an habit therapy program at Boston Medical Center, scanned her med checklist. It confirmed a prescription for the opioid-reversal drug naloxone — model identify Narcan.
“But I’m a nurse, I use it to help people,” Isela informed her agent. “If there is an overdose, I could save their life.”
That’s a message public well being leaders goal to unfold far and extensive. “Be prepared. Get Naloxone. Save a life,” was the message on the prime of a abstract advisory from the U.S. surgeon normal in April.
But some life insurers think about the usage of pharmaceuticals when reviewing coverage candidates. And it may be troublesome, some say, to inform the distinction between somebody who carries naloxone to avoid wasting others and somebody who carries naloxone as a result of they’re in danger for an overdose.
Primerica is the insurer Isela mentioned turned her down. (NPR and KHN have agreed to make use of simply Isela’s first identify as a result of she is nervous about how this story may have an effect on her ongoing effort to get life insurance coverage.) The firm mentioned it could’t talk about particular person circumstances. But in a ready assertion, Primerica famous that naloxone has grow to be more and more obtainable over-the-counter.
“Now, if a life insurance applicant has a prescription for naloxone, we request more information about its intended use as part of our underwriting process,” mentioned Keith Hancock, the vp for company communications. “Primerica is supportive of efforts to help turn the tide on the national opioid epidemic.”
After Primerica turned her down, Isela utilized to a second life insurer and was once more denied protection. But the second firm informed her it’d rethink if she obtained a letter from her physician explaining why she wants naloxone. So, Isela did contact her major care doctor — after which realized that her physician had not prescribed the drug.
Isela purchased naloxone at a pharmacy. To assist cut back overdose deaths, Massachusetts and many other states have established a standing order for naloxone — one prescription that works for everyone. Isela couldn’t simply give her insurer that statewide prescription; she needed to discover the physician who signed it. As it occurs, that doctor — Dr. Alex Walley — additionally works at Boston Medical Center.
Walley is an affiliate professor of drugs at Boston University; he additionally works in habit drugs at Boston Medical Center and is the medical director for the Opioid Overdose Prevention Pilot Program on the Massachusetts Department of Public Health.
“We want naloxone to be available to a wide group of people — people who have an opioid use disorder themselves, but also [those in] their social networks and other people in a position to rescue them,” Walley mentioned.
He mentioned he has written a half-dozen letters for different BMC staff denied life or incapacity insurance coverage due to naloxone, and that troubles him.
“My biggest concern is that people will be discouraged by this from going to get a naloxone rescue kit at the pharmacy,” Walley mentioned. “So this has been frustrating.”
The life insurance coverage problem — and risk of being turned down — has discouraged Isela and a few of her fellow nurses. She will not be carrying a naloxone package outdoors the hospital proper now as a result of she doesn’t need it to point out up on her lively treatment checklist till the life insurance coverage downside is sorted out.
“So if something were to happen on the street, I don’t have one — just because I didn’t want another conflict,” Isela mentioned.
BMC has alerted the state’s Division of Insurance, which has mentioned in a written response that it’s reviewing the circumstances and drafting tips for “the reasonable use of drug history information in determining whether to issue a life insurance policy.”
But Isela isn’t a drug person. And but, she is being penalized as if she have been.
Michael Botticelli, who runs the Grayken Center for Addiction Medicine at BMC, mentioned family and friends members of sufferers with an habit should have the ability to carry naloxone with out worry that doing so will ship them to the insurance coverage reject pile.
“It’s incumbent on all of us to make sure that we try to kind of nip this in the bud,” he mentioned, “before it is any more wide-scale.”
Botticelli mentioned elevated entry to naloxone throughout Massachusetts is likely one of the major causes overdose deaths are down within the state. The most up-to-date state report confirmed 20 fewer fatalities by way of the primary 9 months of 2018 in contrast with the identical interval in 2017.
Botticelli relayed his considerations in a letter to Dr. Jerome Adams, the U.S. surgeon normal, who says he contacted the National Association of Insurance Commissioners. That group says it has not heard of any circumstances of life insurance coverage candidates being denied as a result of they bought naloxone.
Adams mentioned it’s good to — as Botticelli suggests — nip the issue within the bud.
“Naloxone saves lives,” Adams mentioned, “and it is important that all Americans know about the vital role bystanders can play in preventing opioid overdose deaths when equipped with this lifesaving medication.”
Isela mentioned the second firm that rejected her has agreed to let her reapply, in mild of Walley’s letter stating that she carries the drug in order that she will reverse an overdose. Isela is within the means of reapplying.
This story is a part of a partnership that features WBUR, NPR and Kaiser Health News.
