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A pharmacist at Mayo Pharmacy in Bismarck, N.D., reviews completed pharmaceutical orders in January. Advocates, providers, medical associations and state lawmakers are pushing for insurers to cover non-opioid pain medications. (Photo by Michael Achterling\/North Dakota Monitor)<\/p>\n
More states are requiring their Medicaid programs and health insurance companies to cover non-opioid pain medications as an alternative to opioids, which can be cheaper for insurers but also more addictive for patients.<\/p>\n
Advocates, providers, medical associations and state lawmakers are pushing for parity in coverage. That means prohibiting insurers from charging higher copayments for non-opioids than they do for opioids, and barring them from requiring prior authorization or step therapy \u2014 mandating that patients try other medications first \u2014 before they will cover non-opioid drugs.<\/p>\n
At least eight states have enacted such laws: Arkansas, Illinois, Louisiana, Maine, Massachusetts, Oklahoma, Oregon and Tennessee. In states that are still considering legislation, the efforts have been bipartisan, pushed by lawmakers in Democratic-controlled states such as Colorado and New York and Republican-leaning states including Kentucky and Missouri.<\/p>\n
The issue has gained momentum in recent years, as leading medical associations such as the American Society of Regional Anesthesia and Pain Medicine have urged providers not to prescribe opioids as the first-line treatment for pain. Meanwhile, bipartisan legislation introduced<\/a> in Congress last year aims to increase Medicaid Part D enrollees\u2019 access to non-opioid pain medications. It\u2019s been referred to a committee.<\/p>\n Dr. Patrick Giam, president of the American Society of Anesthesiologists, said the organization \u201cbelieves it is important that insurance plans make non-opioid therapies as accessible to patients as opioid-based therapies.\u201d<\/p>\n Suzetrigine<\/strong><\/p>\n The U.S. Food and Drug Administration last year approved a new drug called suzetrigine, under the brand name Journavx, the first non-opioid pain relief medication in a new class of analgesic drugs.<\/p>\n<\/div><\/div>\n Non-opioid pain medications include prescription-strength anti-inflammatory NSAIDs such as naproxen and ibuprofen, nerve-blocking injections, certain antidepressants, anticonvulsant medications, acetaminophen and other medications. Opioids include oxycodone, codeine, morphine and fentanyl. The U.S. Food and Drug Administration has encouraged non-opioid pain relief alternatives.<\/p>\n Last year, the agency approved<\/a> a new drug called suzetrigine, under the brand name Journavx, the first non-opioid pain relief medication in a new class of analgesic drugs. The drug, which is available in tablets, can be prescribed for acute pain after surgery or injury. Vertex Pharmaceuticals, the manufacturer, is one of the funders of Voices for Non-Opioid Choices, which has been lobbying for the bills.<\/p>\n In Missouri, where GOP-sponsored legislation<\/a> would prohibit insurance companies from denying coverage of a prescribed non-opioid or requiring a higher copayment for a non-opioid, the Missouri Insurance Coalition has argued<\/a> that the measure would increase health care costs and effectively create \u201ca monopoly\u201d for Journavx. Each tablet can cost<\/a> around $15 per tablet out-of-pocket. But lawmakers pointed to non-opioid alternatives.<\/p>\n Newer non-opioid drugs entering the market are more expensive than opioids because there isn\u2019t yet a generic alternative, explained Sterling Elliott, an Illinois clinical pharmacist and lecturer at Northwestern University\u2019s Feinberg School of Medicine and a board member of Voices for Non-Opioid Choices.<\/p>\n \u201cThe price is so high for a lot of things because the price for generic opioids is so low. Generic opioids are amongst the cheapest medications that you\u2019ll find flowing through the American pharmaceutical supply,\u201d Elliott said. \u201cWhen you get a new entrant into the pain market, the marketplace factors are set up to drive the price up.\u201d<\/p>\n Elliott added that some insurance plans don\u2019t cover prescription-strength NSAIDs such as ibuprofen because they\u2019d rather people pay out-of-pocket for lower strength, over-the-counter versions of those drugs.<\/p>\n In New York, Democratic Assemblymember Phil Steck, the cosponsor of a bipartisan bill that hasn\u2019t received a hearing, said challenging the insurance companies isn\u2019t easy.<\/p>\n \u201cYou\u2019re trying to tell insurers what to do,\u201d Steck said. \u201cThose are usually difficult undertakings. \u2026 Our experience is that the [legislature\u2019s] insurance committee is very difficult to deal with, and so it hasn\u2019t been pursued as much as we would like.\u201d<\/p>\n Coverage of non-opioids can vary widely across insurance plans, explained clinical pharmacist Emma Murter, who co-chairs the advocacy committee of the Society of Pain and Palliative Care Pharmacists.<\/p>\n \u201cThere are so many [non-opioid] medications that can be used for chronic pain,\u201d Murter said. \u201cIt isn\u2019t gut-instinct obvious, what is and isn\u2019t covered. It\u2019s very Wild West, chaotic.\u201d<\/p>\n When it comes to filling prescriptions, Murter said, she often has to \u201cfight and appeal for some of these non-opioid therapies\u201d with insurance companies.<\/p>\n Dima Qato, associate professor of clinical pharmacy at the University of Southern California, said non-opioid pain prescription meds are less common on insurance companies\u2019 \u201cpreferred\u201d drug lists. Because insurers may favor the less expensive opioids, that can result in higher copayments or consumers paying more out-of-pocket.<\/p>\n That was the case for Chris Fox, the Washington lobbyist who serves as executive director of Voices for Non-Opioid Choices. Fox has traveled to state capitals around the country to lobby for the bills. Recently, he had a personal experience with pain medications following oral surgery.<\/p>\n \u201cFor everything but the non-opioid, my out-of-pocket expectation was $0,\u201d he said. He was charged $30 out-of-pocket for the non-opioid.<\/p>\n His oral surgeon wasn\u2019t familiar with the availability of the new first-in-class non-opioid suzetrigine, Fox added. When he asked the doctor for a prescription for it, the surgeon wrote it but also prescribed an opioid along with an antibiotic.<\/p>\n \u201cHe prescribed me hydrocodone to go along with it, just in case, because he wasn\u2019t as familiar with [suzetrigine],\u201d Fox said.<\/p>\n As he spoke with Stateline by phone, Fox was driving to the local sheriff\u2019s office to drop off the hydrocodone, which he didn\u2019t take following his surgery.<\/p>\n \u201cWe\u2019ve neglected the opportunity, I would say, to prevent opioid addiction where we can, which is in those patients that will develop a newly persistent opioid use pattern following exposure to an opioid that they get for medical reason,\u201d Fox said.<\/p>\n Although opioid overdose deaths have declined, the drugs still kill about 200 Americans a day.<\/p>\n Health care professionals at hospitals also run into issues with lower reimbursement rates for some non-opioids.<\/p>\n Dr. Joseph Smith, an anesthesiologist at a Virginia surgical center who has practiced for three decades, pointed to a nerve-block pain pump as an example. Administering a brand-name version of the drug could cost up to $400 for all the equipment, he said. Smith, like Elliott, sits on the board of Voices for Non-Opioid Choices.<\/p>\n \u201cSo the hospital is like, \u2018Well, I can spend $400 or I can spend 25 cents on a narcotic pill,\u2019\u201d Smith said.<\/p>\n Smith treats many young teen athletes with sports injuries. Research has shown post-surgery narcotic use can increase risk of addiction.<\/p>\n \u201cMy goal when I get a 14-year-old or 15-year-old in here is to never have them try a narcotic, never have them exposed to narcotics,\u201d he said.<\/p>\n Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org<\/a>.<\/em><\/p>\n\n\nWhy non-opioids often cost more<\/h4>\n
Preventing addiction<\/h4>\n