A study released by the Journal of the American Medical Association found that insurers such as Medicare limit access to certain medications such as buprenorphine, which is used to treat opioid addiction. This is due in part to the pre-authorization requirements used by insurers to control costs when prescribing medication.

As a result, these restrictions may be contributing to the already-growing opioid epidemic.

Medication-Assisted Treatment

As part of medication-assisted treatment (MAT), buprenorphine helps addicts to quit or reduce their use of heroin and other opiates, such as pain relievers like Oxycontin and morphine. MAT provides a whole-patient approach to addiction treatment, with the use of medications like buprenorphine in conjunction with behavioral therapy and counseling. According to Dr. Todd Korthuis, study co-author and chief of the addiction medicine section at Oregon Health and Science University, "Buprenorphine is a safe and effective treatment that decreases deaths due to opioids and stops heroin and other opioid use. People on buprenorphine are able to get their lives back together."

The study found that between 2007 and 2018 pre-authorization requirements progressively limited the use of buprenorphine for Medicare Part D beneficiaries. Researchers based this finding on an analysis of prescription drug plan data for the corresponding years. The most common reason that insurers use pre-authorization requirements is to limit access to specific drugs in order to control costs. In the case of buprenorphine, limited access may reflect societal stigma related to addiction, as well as inaccurate perceptions of buprenorphine's health risks.

Buprenorphine for Opioid Addiction

Buprenorphine is one of only three medications approved by the FDA for treating opioid addiction. Because the drug eases pain and withdrawal symptoms, it is vital—in conjunction with behavioral and cognitive therapies—for saving addicts from overdose and continued dependence on heroin and other opiates. Since Medicare has not historically covered methadone, addicts insured by Medicare are becoming increasingly more susceptible to the dangers of opioid addiction, including overdose and death.

Due to mistaken perceptions of addiction as a moral affliction, the general population doesn't understand how crucial MAT can be in the recovery of opioid addicts. In an article published by Opioid Help, Korthuis explains that "many people still believe that medication treatment isn’t really recovery. Overwhelming scientific evidence supports that medicines like Buprenorphine are far more successful and safer than abstinence-only approaches. Buprenorphine saves lives. Abstinence-based approaches don’t.”

Raising Awareness

As a recovering addict with a dual diagnosis of generalized anxiety disorder, I understand the importance of raising social awareness about addiction and the effectiveness of addiction treatment programs, so that insurers may follow suit by covering effective approaches to treatment. Without health insurance that covered a whole-patient approach to my treatment, I would not have been successful in abstaining or, more importantly, maintaining sobriety. Inpatient treatment for my addiction—which included psychiatric evaluation, therapy, counseling, and support groups—is the reason I'm able to live a happy and sober life today.

I also understand that addiction treatment is a complicated issue because I saw my loved ones perplexed, frustrated and dejected in regards to my addiction and the behavior that came along with it. As much as they wanted to understand, they just couldn't. However, with more awareness raised, more experiences shared and more scientifically based studies conducted, the ripple effect of understanding the importance of access to medication will become far-reaching.

Hopefully, awareness of this issue will reach as far as to have a positive impact on the way insurers view the importance of addiction treatment.

If you or someone you know needs help finding a provider to treat opioid addiction, please visit our directory of treatment centers or call 800-772-8219 to discuss treatment options.