Insurance Rules Can Hamper Recovery From Opioid Addiction : Shots - Health News Medicaid and other health insurers require doctors to file time-consuming paperwork before allowing them to prescribe drugs that help people quit opioids. That delay fosters relapse, specialists say.
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Insurance Rules Can Hamper Recovery From Opioid Addiction

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Insurance Rules Can Hamper Recovery From Opioid Addiction

Insurance Rules Can Hamper Recovery From Opioid Addiction

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STEVE INSKEEP, HOST:

The roadblock to attacking the drug addiction crisis - it is hard for people to get medications that help them recover, hard even if they have insurance. Drugs like Suboxone are supposed to address addictions to heroin and painkillers. Here's Jake Harper of Side Effects Public Media.

JAKE HARPER, BYLINE: Twice a day, Angela and Nate Turner take a tiny strip that looks almost like colored scotch tape and put it under their tongues.

ANGELA TURNER: They taste disgusting.

HARPER: She says it's worth it. That strip is actually a drug called Suboxone. The married couple got addicted to painkillers several years ago following separate injuries. They both decided to go into recovery this year. Suboxone helps them control their cravings.

A. TURNER: Just don't have them withdrawals and you feel normal. But you're not high. It's like a miracle drug, really, it is.

HARPER: Angela can take care of their 3-year-old daughter and Nate can keep a job. They don't have to think about how they'll get drugs or how sick they'll feel if they don't. But getting started on Suboxone took time. Angela says she had to wait three days to get her prescription filled, which put her into withdrawals.

A. TURNER: Lying in bed going through cold sweats, hot sweats...

NATE TURNER: Diarrhea.

A. TURNER: ...Diarrhea, legs aching, pain.

HARPER: For Nate, the wait was five days. On day three, he relapsed and used heroin.

N. TURNER: I swore to myself I was done so that when - and then when I went back to having to use it, I just thought it was over, that I wasn't going to make it back to the program.

HARPER: Suboxone is covered through the Turners' health insurance plan, which is part of Indiana's Medicaid. But before their insurance company will pay for it, doctors and nurses have to get approval known as a PA, prior authorization. The process frustrates Andy Chambers, an addiction psychiatrist in Indianapolis.

ANDY CHAMBERS: This will include phone calls, filling out forms, sometimes writing essays, going through appeal processes.

HARPER: He says his nurses spend about 30 hours a week on all this.

CHAMBERS: It's almost like when you take on a patient to treat Opiate addiction, you also have to take on another patient called the insurance company.

HARPER: Getting a prior authorization can take days or weeks depending on the drug and the insurance company. PA requirements can also pressure doctors to change how they prescribe. Sometimes an insurer will push for a lower dosage than the doctor wants or it'll require the doctor to wean a patient off of a medication sooner than the doctor would recommend.

CHAMBERS: These rules and regulations for us completely block the correct provision of care. And that's crazy.

HARPER: And for some insurers, a prior authorization expires after just a few months. Indiana Medicaid has started to allow some doctors to skip that initial back and forth with the insurance company. But Chambers says it hasn't helped him much yet. Sam Muszynski is with the American Psychiatric Association. He says patients are vulnerable during these delays.

SAM MUSZYNSKI: You may lose that opportunity right then and there. They may never come back.

HARPER: He and other experts say the use of prior authorizations for addiction medications is widespread. As of 2013, Medicaid in 48 states required a PA to prescribe Buprenorphine, the active ingredient in Suboxone.

MUSZYNSKI: There's a continuing pattern of discrimination, which results in reduced access to people who need Opioid addiction treatment.

HARPER: Muszynski says the use of prior authorizations is one way insurers limit what they pay for. And they use PAs more often with mental health and addiction treatments compared to other medical treatments. Nate Turner has managed to stay in treatment despite the prior authorization process. He says there's an irony here.

N. TURNER: I can assure you if I was on regular pain medicine, I'd be able to get them no problem.

HARPER: He says he got started on Opioids without a prior authorization. He shouldn't need one to help him stop. For NPR News, I'm Jake Harper in Indianapolis.

INSKEEP: That story's part of a reporting partnership with WFYI and Kaiser Health News

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