Insurers Are Starting To Deny Coverage of Opioid OxyContin : Shots - Health News Embattled drugmaker Purdue Pharma defends OxyContin as some insurers are dropping the drug in favor of other abuse-deterrent opioid painkillers.
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Insurer To Purdue Pharma: We Won't Pay For OxyContin Anymore

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

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

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ARI SHAPIRO, HOST:

Purdue Pharma, the maker of OxyContin, is the subject of dozens of lawsuits around the country. Now the largest insurer in Tennessee has announced it will no longer cover prescriptions for what was once a blockbuster pain reliever. Blake Farmer of member station WPLN in Nashville reports.

BLAKE FARMER, BYLINE: OxyContin was designed to be difficult to misuse, pain relief delivered over a longer time. But when crushed and snorted or liquefied and injected, the extended-release tablets turn into a potent rush. Natalie Tate is the top pharmacist at Blue Cross Blue Shield of Tennessee and says the newest abuse-deterrent opioids work better. And so starting in January, the giant insurer will cover those instead.

NATALIE TATE: We felt it was time to move to those products and remove OxyContin from the formulary, which still does continue to have a higher street value.

FARMER: The newest drugs are more expensive, but Tate says Blue Cross will pay the difference. In a page-long response, a Perdue Pharma spokesman points out that no drug is abuse-proof or less addictive, accusing Blue Cross of financial motives. Tate says ditching one of the most recognized names in opioids is not designed to save money, though it might in a roundabout way. Pharmacist Jeffrey Fudin, who's a professor specializing in pain, says he's no fan of Blue Cross, but he applauds the decision.

JEFFREY FUDIN: Yes, it's a smart idea to use dosage forms that have been proven to be better abuse-deterrent formulations so that in the long run, it actually will cost them a whole lot less money.

FARMER: Fudin says insurers could cut down on prescriptions that get misused and costly hospital stays for overdoses. Practicing pain physicians in Tennessee say OxyContin was already falling out of favor. But they have a more basic problem with how insurers cover pain treatment. Many are quick to deny coverage of alternative therapies like muscle relaxers or nerve-numbing procedures. Stephanie Vanterpool, the incoming head of the Tennessee Pain Society, says there are better medications for the patient.

STEPHANIE 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.

FARMER: Blue Cross of Tennessee is adding some alternative pain therapies in the coming year. But Vanterpool is really talking about a philosophical about-face. Not to say Oxycontin won't be sorely missed by some patients.

TERRI LEWIS: There are plenty of people who benefit from that drug.

FARMER: Terri Lewis is a patient advocate from Cookeville, Tenn. She's suspicious of Blue Cross' motives since the insurer has a corporate image to protect. Purdue Pharma could be a convenient scapegoat.

LEWIS: Maybe this is a good decision, but it smells like a political decision.

FARMER: And this would be just the latest political decision targeting a nuanced medical problem. The state Legislature instituted the tightest opioid prescribing regulations in the country this year, 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.

JOHN VENABLE: I just felt like I was in a hopeless state. This is my life - to wake up every morning with a headache so bad that death would be a relief.

FARMER: Despite that bleak outlook, he's noticed something surprising over the last few months. Without the opioids, his crippling headaches aren't that much worse, if at all.

VENABLE: It very well might be a blessing in disguise.

FARMER: Venable, a builder and onetime pastor, says he prays that those losing OxyContin might also find they can manage without. But he worries some could also turn to more dangerous street drugs. For NPR News, I'm Blake Farmer in Nashville.

SHAPIRO: This story is part of a reporting partnership that includes WPLN, NPR and Kaiser Health News.

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