New study shows regulators have overlooked insurers in tackling the opioid epidemic.
A new war on drugs is taking place—and this time, it is being waged against prescription opioid abuse. Deaths from prescription opioid overdoses have more than quadrupled since 1999, and more than 10 million people aged 12 or older misused these drugs last year.
Medical professionals prescribe opioids to treat pain from injuries, surgeries, and chronic diseases. Insurers play a key role in such treatment because they allow insureds—that is, people covered by health insurance—to get prescription opioids without incurring overwhelming costs.
But in a recent article, one legal scholar argues that regulators have “widely ignored” the role insurers should play in addressing the epidemic, despite being central to the problem.
Regulation has failed to require insurers to cover substance addiction treatment programs across the uninsured and the country’s “various types of health insurance programs,” explains Valarie K. Blake, a professor at West Virginia University College of Law. Blake thus proposes that federal regulators “leverage the overwhelming bipartisan backing of opioid reforms” to press Congress for “expansive coverage” of such programs through “uniform regulation.”
Congress’s passage of the Mental Health Parity and Addiction Equity Act in 2008, according to Blake, is a clear sign of emerging political support for addressing the opioid problem. After amassing more than 70 votes in the Senate and 260 votes in the House of Representatives, the Act expands the ability of several federal agencies—including the U.S. Department of Health and Human Services and the U.S. Department of Labor—to provide insurance coverage to opioid abusers. To this end, the Act requires insurers to provide the same level of benefits for substance abuse services that they do for standard medical health care.
Unfortunately, Blake asserts, more than two-thirds of state health insurance plans have failed to comply with mental health parity laws—indicating that the federal government’s job is far from over. Indeed, Blake notes that approximately 10 percent of the non-elderly population lacks health insurance, and among that population are thousands of opioid abusers who live in rural areas in which substance abuse services are not offered.
Furthermore, Blake contends that insurance discrimination against opioid addicted insureds is likely because insurers are “wired” to reduce exposure to expensive health care consumption. Health insurance spending has increased more than threefold over the last several years—snowballing from $2.3 billion in 1999 to $7.4 billion in 2012. A recent white paper published by FAIR Health indicates that private insurers assume average costs of $3,453 per year covering an insured. When insurers cover opioid addicts, however, costs increase to $19,333.
Because treating an opioid-addicted patient is more expensive than treating an average patient, Blake advocates that state regulators should adopt mechanisms to prevent insurers from discriminating against those in need.
Blake acknowledges that the Affordable Care Act (ACA) affords patients the right to insurance coverage and premiums, even if they suffer from “preexisting conditions,” such as opioid addiction. Despite the alleged promise of such a regulatory mechanism, Blake expresses concerns about the Trump Administration’s threats of rolling back the ACA altogether and the impact that such a rollback could have on those suffering from opioid addiction.
In preventing the risk of a federal regulatory rollback, Blake suggests that state regulators create or bolster regulations aimed at monitoring drug consumption among high-risk patient populations. For instance, state-level prescription drug monitoring programs force prescribers to input data about patients—including their names and the drug’s “dose and type”—whenever they prescribe prescription opioids. With such measures in place, pharmacists can thus track patient drug use and, in turn, prevent over-prescription of addictive drugs.
Blake also argues that state and federal regulators largely have failed to encourage insurers to align their services and policies with broader public health goals. Consequently, Blake adds, insurers focus on their insured population and turn a blind eye to the rest of the U.S. population.
Opioids are only one example Blake cites of a disconnect that can arise between insurance practices and public health needs. She recounts a measles epidemic in Wisconsin that occurred because a state public insurer was not forced to cover vaccination as part of its benefits. If insurers are not compelled to curtail public health hazards, Blake argues, they may avoid covering costly services—such as statewide vaccination programs—to reduce expenses.
Despite the alleged discrepancy between health insurance practices and public health goals, Blake concedes that a few cases of fruitful insurer–public health alignment have occurred in recent years. For instance, Medicare—the federal public health insurance program covering older Americans—adopted a benefit program called Medicare Part D in 2006, which enables insureds to get prescription opioids and “control their medical conditions affordably.” Since the program’s adoption, Medicare has led the nation in opioid prescription reimbursements—an accomplishment regulators should look to in addressing the opioid epidemic, Blake maintains.
In light of the impact insurers have on prescriber behaviors, regulators should bolster current initiatives and capitalize on health insurance advances. According to Blake, such reforms may be the only way forward.
