Tagged Insurers

Must-Reads Of The Week From Brianna Labuskes

If you’ve been glued to your preferred weather service (as I have) over the past few days watching Hurricane Florence lumber toward the East Coast, you may have missed that it was a fairly huge news week for health. So, let’s get right to it!

President Donald Trump shocked and angered both allies and critics with accusations that the latest death toll from Hurricane Maria was inflated by the Democrats to make him look bad.

Bloomberg: Trump Defies Science With Rejection of Puerto Rico Death Toll

4 Takeaways On Puerto Rico’s Death Toll, In The Wake Of Trump’s Tweet Storm

For the first time since 2010, the decline in the uninsured rate stalled. Some blame the Trump administration’s whacks at the health law, but others say it’s just the marketplace leveling off.

The Washington Post: For First Time Since 2010, America’s Progress on Health Insurance Stalls

The fact that Sen. Joe Manchin (D-W.Va.) is using health care while campaigning in a deep-red state that loves Trump shows just how far politics has evolved on the issue. (Even though he’s certainly not mentioning “Obamacare” by name.)

The New York Times: Manchin Counts on Health Care to Stave Off Republican Tide in West Virginia

But a look at tweets on the topic shows it doesn’t matter to Russian trolls which way that popularity pendulum swings — they recognize the health law as a plank sure to sow discord and pit sides against each other.

The Wall Street Journal: Nearly 600 Russia-Linked Accounts Tweeted About the Health Law

Baltimore health commissioner Dr. Leana Wen, an emergency room physician with a reputation for fiercely taking on the Trump administration, has been tapped as Planned Parenthood’s next president. Wen brings firsthand experience with the organization as a child of a low-income family.

The New York Times: Planned Parenthood Names Leana Wen, a Doctor, Its New President

More than 4,300 beneficiaries in Arkansas were kicked off the state’s Medicaid rolls after failing to report their required work hours. Republican Gov. Asa Hutchinson focused on the 1,000 or so residents who have found employment under the new regulations, but critics were quick to point to the number as confirmation of their worst fears that the new fervor for work requirements will lead to a lot of Americans losing insurance.

The Associated Press: Arkansas Drops 4,300 From Medicaid Plan Over New Work Rules

A letter alleging a sexual misconduct incident in Supreme Court nominee Brett Kavanaugh’s past, which Sen. Dianne Feinstein (D-Calif.) has turned over to the FBI, is adding fuel to an already fiery battle on the Hill.

A Sexual-Misconduct Allegation Against the Supreme Court Nominee Brett Kavanaugh Stirs Tension Among Democrats in Congress

Meanwhile, accusations of bribery are coming out of Maine, where advocates have guaranteed $1 million in fundraising pledges to Republican Sen. Susan Collins’ 2020 opponent if she votes to confirm Kavanaugh.

The Associated Press: $1 Million Pledged Against Collins If She Backs Kavanaugh

A pharma exec’s defense that raising drug prices 400 percent was a “moral requirement” raised more than a few eyebrows. It was a bold claim in an era where most companies are trying to at least appear concerned about the topic.

Financial Times: Pharma Chief Defends 400% Drug Price Rise As a ‘Moral Requirement’

Want to know how those pharmacy benefit managers (yup, the ones now getting lots of fingers pointed at them for the high cost of drugs) can pocket almost $200 for a bottle of pills that’s valued at $6? Check out Bloomberg’s explainer.

In the interest of making this “breezy,” here are some other big news stories from the week: Apple kills two birds with one stone with its new watch: convincing people they need to buy a low-selling product and edging into the health care industry; the number of immigrant teens being held by the government has ballooned; and lawmakers may perform what might be called, in this partisan landscape, a miracle and actually fund the government on time. (See, I was not exaggerating about the amount of news this week!)

Stat: The New Apple Watch, With FDA’s Blessing, Comes With an EKG App

The New York Times: Detention of Migrant Children Has Skyrocketed to Highest Levels Ever

Stat: Trump Wants Drug Prices in TV Ads. The Latest Roadblock? Republicans

Politico: Congress Dares Trump To Shut Down The Government In New Spending Deal

In a story that you can’t make up: A member of the family that owns Purdue Pharma (the maker of OxyContin and subject of more than 1,000 lawsuits regarding its role in the opioid epidemic) has been awarded a patent for a treatment for opioid use disorder.

Stat: Richard Sackler, Member of Clan Behind OxyContin, Has Patent for Opioid Treatment

If all of that wasn’t enough for you, here are a few must-read miscellaneous stories from the week: Nearly two decades after Kendra Webdale was pushed to her death in the subway, the law named in her honor designed to shore up mental health systems is acting more like a band-aid than a cure; advocates are shifting gears on gun safety by going after bullets, which are largely unregulated; recent transparency controversies have some asking: Why do medical journals still take authors at their word?; and a look at the people behind suicide hotlines.

The New York Times: A Horrific Crime on the Subway Led to Kendra’s Law. Years Later, Has It Helped?

The New York Times: California Tries New Tack on Gun Violence: Ammunition Control

Stat: Why Do Medical Journals Keep Taking Authors at Their Word?

CNN: When Someone Is Thinking of Suicide, These Are the People Who Talk Them Out of It

If you had a gloomy 2017, at least take heart in the fact that it wasn’t just you.

Please have a safe weekend if you’re in Florence’s path!

Insurer To Purdue Pharma: We Won’t Pay For OxyContin Anymore

The largest insurer in Tennessee has announced it will no longer cover prescriptions for what was once a blockbuster pain reliever. It’s the latest insurance company to turn against OxyContin, whose maker, Purdue Pharma, faces dozens of lawsuits related to its high-pressure sales tactics around the country and contribution to the opioid crisis. Last fall, Cigna and Florida Blue both dropped coverage of the drug.

Top officials at BlueCross BlueShield of Tennessee say newer abuse-deterrent opioids work better, and starting in January, the insurer covering 3.4 million Tennesseans will pay for those opioids made by other pharmaceutical companies instead.

“We felt it was time to move to those products and remove Oxycontin from the formulary, which does still continue to have a higher street value,” said Natalie Tate, the insurer’s vice president of pharmacy.

OxyContin was reformulated in 2010 to make the drug harder to misuse — but it’s still possible to crush or liquefy in order to snort or inject it.

The latest long-acting opioids that BlueCross BlueShield of Tennessee is going to start covering — Xtampza and Morphabond — are still more difficult to misuse, according to the company and some pharmaceutical experts.

Motives Questioned

In a page-long response a reporter’s query, a Purdue Pharma spokesman pointed out that no opioid drug is “abuse proof” or less addictive, accusing BCBST of financial motives that remove choices for many patients.

“We believe that patients should have access to FDA-approved products with abuse-deterrent properties,” Purdue’s Robert Josephson wrote in an email. “The recent decision by BlueCross BlueShield of Tennessee limits prescribers’ options to help address the opioid crisis.”

In response, BCBST’s Tate argued that ditching one of the most recognized names in opioids is not designed to save money, though it could in a roundabout way.

This move could reduce fraudulent prescriptions to street dealers or drug-seeking people with active addictions and cut down on costly hospital stays for overdoses, said pain consultant and pharmacist Jeff Fudin, an adjunct professor at Albany College in New York.

“It’s a smart idea to use dosage forms that have proven to have been better abuse-deterrent formulations,” he said. “In the long run, it actually will cost them a whole lot less money.”

Fudin said he’s often at odds with insurers over their decisions about which drugs to cover, but he applauds this decision, which he expects more insurers to follow.

Alternative Therapies

Practicing pain physicians in Tennessee — who regularly battle with insurance companies — also approve of the change, though they said OxyContin was already falling out of favor. And they argue trading one opioid for slightly safer ones doesn’t address a larger gripe that physicians have with insurers over paying for other, non-addictive types of treatment.

“We will have denials and prior authorizations on a muscle relaxer, and we will have no issue getting an opioid through the insurance company,” said Dr. Stephanie Vanterpool, an anesthesiologist at the University of Tennessee and the president-elect of the Tennessee Pain Society.

“The physicians or the doctor’s offices jump through hoops to get the better medication for the patients,” said Vanterpool. “And when I say better medication, I mean the medication that’s treating the cause of the pain, not just the medication that’s covering up the pain.”

BlueCross BlueShield of Tennessee is adding some alternative pain therapies in the coming year, according to its announcement last week. But Vanterpool would like to see a philosophical about-face.

Not to say OxyContin won’t be sorely missed by some patients.

“There are plenty of people who benefit from that drug,” said Terri Lewis, a patient advocate and rehabilitation specialist from Cookeville, Tenn.

She’s suspicious of BCBST’s motives since the insurer may be blamed for its role in the opioid crisis. Embattled Purdue Pharma could be a convenient scapegoat.

“Maybe this is a good decision,” Lewis said. “But it smells like a political decision.”

And this would be just the latest decision inserting politics into a nuanced medical problem.

A Blessing In Disguise?

The Tennessee legislature instituted some of the tightest opioid prescribing regulations in the country this year — a three-day limit for most people who aren’t already on opioids. And even long-term pain patients are having trouble getting refills.

John Venable of Kingsport, Tenn., was shown the door by his pain clinic in July after more than a decade on oxycodone — a generic, short-acting version of OxyContin.

“I just felt like I was in a hopeless state, like, ‘there is no help for John,’” he recalled.

At their worst, he said his headaches get so debilitating “that death would be a relief.” Despite his dread, he’s noticed something surprising over the last few months without opioids — his crippling headaches haven’t gotten that much worse, if at all.

“It very well might be a blessing in disguise,” Venable said.

The retired builder and one-time pastor said he prays that those losing OxyContin also will get to use the moment as an opportunity, though he knows many can’t cut ties with opioids. And he worries some will turn to more dangerous drugs off the street or even contemplate ending their own lives.

Experts point out that the number of opioid prescriptions has already been falling around the country. And in Tennessee, BCBS has experienced a 26 percent drop in opioid prescription claims over three years.

But restricting legal access to opioids hasn’t turned back the rise in overdose deaths, which hit a record in Tennessee and nationwide last year.

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.