Study: Le­gal opi­oids easy to get

Many in­sur­ers’ rules lack re­stric­tions on some drugs

The Middletown Press (Middletown, CT) - - FRONT PAGE - By Ed Stan­nard

NEW HAVEN — While in­surance plans have in­creased re­stric­tions on the pre­scrib­ing of opi­oids, the highly ad­dic­tive drugs are still eas­ily ob­tain­able with­out lim­its such as re­quir­ing prior au­tho­riza­tion, ac­cord­ing to a Yale Univer­sity study.

The re­searchers com­pared for­mu­la­ries for Medi­care plans from 2006, 2011 and 2015 and found that two-thirds of these drugs were sub­ject to re­stric­tions. One-third, how­ever, did not have such lim­its.

“I think we all know that we’re in a na­tional opi­oid cri­sis right now, and we need to know what may be con­tribut­ing and we need to have all pos­si­ble strate­gies at our dis­posal to help curb this cri­sis,” said Dr. San­ket Dhruva, a car­di­ol­o­gist at the Yale School of Medicine and mem­ber of the re­search team, on Monday.

The study was pub­lished Monday in the An­nals of In­ter­nal Medicine.

The re­searchers com­pared Medi­care Ad­van­tage and Part D for­mu­la­ries for 2006, 2011 and 2015 be­cause Medi­care is of­ten a stan­dard other in­sur­ers use for their for­mu­la­ries. “Essen­tially, for­mu­la­ries de­ter­mine the avail­abil­ity of these med­i­ca­tions,” Dhruva said.

“If the drugs are avail­able, the in­surance com­pa­nies can use one of three strate­gies,” he said. They may re­quire prior au­tho­riza­tion from the in­surance com­pany be­fore the pre­scrip­tion will be ap­proved. They can im­ple­ment so-called step ther­apy, in which “a pa­tient must try drug X be­fore he can re­ceive drug Y,” Dhruva said. Or they can limit the quan­tity of drugs that may be dis­pensed at one time.

Con­necti­cut passed a law in 2016 lim­it­ing most opi­oid pre­scrip­tions to seven days, with some ex­cep­tions.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion is­sued guide­lines in 2016 for opi­oid pre­scrip­tions, but the Yale re­searchers found these were not al­ways fol­lowed.

“Still, a large num­ber of opi­oids don’t have re­stric­tions im­posed on them,” Dhruva said. “We want to make sure that opi­oids are go­ing to pa­tients that are go­ing to ben­e­fit and are not go­ing out in high doses.”

Com­par­ing for­mu­la­ries from 2006 with 2015, “It’s an im­prove­ment, but I still think we have a ways to go,” he said.

More than 900 peo­ple died in Con­necti­cut in 2016 of drug over­doses, ac­cord­ing to the state’s chief med­i­cal ex­am­iner’s of­fice.

Dr. Dan Knecht, head of clin­i­cal strat­egy and pol­icy for Aetna Inc., said the com­pany has in­sti­tuted re­stric­tions on all opi­oid pre­scrip­tions. As of Jan. 1, “For an ini­tial pre­scrip­tion writ­ten, there will be a seven-day limit,” he said.

“A re­search study showed that after a pa­tient re­ceives a pre­scrip­tion of more than seven days of opi­oids, the like­li­hood of abuse dou­bles,” he said.

He said the in­surer sent let­ters to the top one per­cent of opi­oid pre­scribers warn­ing them they are “out­liers.” “We do in­ter­vene on these physi­cians who are ex­ces­sive pre­scribers,” he said.

Knecht also said Aetna en­cour­ages other med­i­ca­tions for pain re­lief, such as Tylenol and ibupro­fen, be­fore opi­oids are pre­scribed. The com­pany also cov­ers treat­ments such as phys­i­cal and oc­cu­pa­tional ther­apy, acupunc­ture and chi­ro­prac­tic, “which are proven treat­ment modal­i­ties that do man­age pain,” he said.

Ac­cord­ing to the CDC, opi­oid pre­scrip­tions peaked in 2010 and de­clined through 2015, but the dosages in­creased dra­mat­i­cally.

“Once you start, it just opens up the door,” Dhruva said. “Of course, (in) the vast ma­jor­ity it doesn’t, but we’ve got young peo­ple dy­ing, we’ve got peo­ple ad­dicted. We’ve got a real prob­lem on our hands.”

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