Insurers, PBMs Scrutinized for Their Role in Opioid Crisis

It’s not just that insurers make it easier for people to obtain addictive opioids than more expensive, but non-addictive counterparts, it’s also that they’ve erected hurdles to addiction treatment, according to a jointly reported article by the New York Times and Pro Publica. HHS is looking into the issue in-depth, but the evidence can be found on formularies.

Every health care stakeholder has been put under the microscope concerning its role in the crisis: drug companies, physicians, pharmacists—to name just three. But health plans and PBMs have, for the most part, not been examined as closely. That appears to be changing.

The New York Times and Pro Publica looked at Medicare prescription plans covering over 35 million people. They found that only one-third of beneficiaries had access to Butrans, a skin patch for pain that’s less risky than the opioid, buprenorphine.

“In contrast, almost every plan covered common opioids and very few required any prior approval,” according to the article.

Source: New York Times