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Kentucky Insurance Companies Fueling Prescription Addiction

The insurance companies in Kentucky have had more than a little to do with the State’s prescription painkiller addiction epidemic. Over 1,000 Kentuckians die every year from drug overdoses, and every year about 1,000 babies are born addicted and have to go through withdrawal, which could take several months. Addia Wuchner, a Republican State Rep in the 66th district since 2005, has introduced a bill that will require insurance companies to cover medications that could help enormously.

According to the Bowling Green Daily News, Kentucky’s problem with prescription drug addiction basically started getting serious in 2001 when the Joint Commission that accredits and certifies health care organizations and programs in the United States changed pain management standards.

“When they came out and said that pain is not being assessed, it created a paradigm shift in physicians treating pain,” Dr. Ram Pasupuleti, a Bowling Green pain management physician. “They introduced pain as a fifth vital sign.”

Hospitals and doctors were required to “recognize the right of patients to appropriate assessment and management of pain monitor pain and to assess and treat it.” But at the same time Medicaid reduced the amount they would pay the doctors for pain treatments such as epidural injections, which are narcotic free.

Doctors had to treat, but their options were limited to narcotics. “You are damned if you do and you are damned if you do not,” is how Pasupuleti described it.

To give you an idea of the disastrous results of that ruling, in the year prior 28 babies were born addicted. By 2014, the number had risen to 955.

Kentucky has been trying to change the scene. The number of prescriptions written for two of the most commonly painkillers have declined about 10 percent. Still, the epidemic rages on.

A major part of the problem is caused by insurance companies refusing to pay for certain kinds of drugs called abuse-deterrent opioids (ADO). Let me explain.

How Abuse-deterrent Opiods Can Help

  1. The sequence of painkiller addiction generally starts either with someone who is genuinely in pain taking them, as directed by their doctor, or someone else grabbing some of the pills out of that person’s medicine cabinet. Unfortunately, whether the drugs were obtained legally or illegally, painkillers don’t necessarily continue working as well as they did when the person first started taking them.
  2. That’s when things accelerate. Wanting to get more out of the drugs, a person first takes more pills and then they move to crushing the pills so they can be snorted or diluting them so they can be injected – which gives them a more dramatic and potent effect. They get high.
  3. When the pills are no longer accessible, many people move to heroin. It’s very accessible, and it costs a fraction of the amount you pay for the pills.

That progression would certainly slow down if the pills were unable to be crushed, and that’s where abuse-deterrent opiods come in. When you try to crush ADO pills, they turn to gel. So they can’t be snorted or liquefied.

But the insurance companies won’t pay for them – even when they are the specific drugs the doctors prescribe. Just another case of insurance companies being able to decide what’s best for a patient – although that’s not really what they’re doing, they’re deciding what’s best for their own profits. Nothing to do with the well-being of the patient.

So, regardless of what they’re prescribed, patients are getting what the insurance company will pay for. And consequently, more people are getting addicted, more lives are being ruined, and more people are dying before their time.

The Bill Rep. Wuchner introduced in February, House Bill 330, will put a stop to that. Not only will insurance companies be forced to pay for ADOs when prescribed by a doctor, they’re also not going to be able to use a bunch of rules to get around it – like putting useless, not medically valid limitations on the circumstances under which a patient can get them.

This Bill will not handle everything, but it could be a significant step in the right direction.

The vote will come on the table in the 2016 session of the Kentucky General Assembly. Check it out and consider giving it your vote.

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