Insurers and PBMs Taking Action on Opioid Abuse 

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access to care. Are these entities a part of the problem or a part of the solution in our nation’s opioid crisis? The answer is both – they are the gateway to these drugs and they make large profits on their dispensing.

But, as this issue heats up, they’re being called upon to be a critical part of the solution in this battle. Insurers have been guilty of limiting patients’ access to safer, less-addictive chronic pain medications and pushing patients towards much cheaper and highly-addictive opioid drugs – most of which need no prior approval and are readily prescribed by doctors. Adding insult to injury, insurers are known for making it harder to access drug addiction treatment than it is to get the drugs from them in the first place.

This year, several states brought multiple lawsuits against Big Pharma for misleading the public on the true, overly-addictive nature of these medications. Intense scrutiny has now come over these meds, which have resulted in more deaths by drug overdose in U.S. history than the crack, meth or past heroin epidemics.

CVS, a PBM, and the health insurer, Cigna, have announced that they will limit the amount of opioid-based scripts written and establish tighter guidelines around morphine-based medications. Cigna announced previously that it was committed to reducing their opioid scripts by 25% by 2019 and reported earlier this year that its customers’ prescribed opioid use was down by nearly 12%. But the big question is, will this simply shift people to illegal drugs such as heroin and – even worse – black market fentanyl, which are already seeing increased traffic?

Who, ultimately, will bear the cost of the destruction of lives and communities, rehabilitation and rebuilding?

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