Lawmaker probes insurers' opioid pricing policies

Hydrocodone opioid pills
The ranking member of the House on Government Oversight and Reform has asked for drug formulary data from UnitedHealth Group, Optum, Humana, CVS Health, Aetna, Anthem and Express Scripts. (Getty/smartstock)

The top Democrat on the House oversight committee wants insurers and pharmacy benefit managers to prove that their drug pricing policies aren’t contributing to the opioid epidemic.

Maryland Rep. Elijah Cummings said Thursday that he sent letters to UnitedHealth Group, Optum, Humana, CVS Health, Aetna, Anthem and Express Scripts requesting that they provide lists of all medications for each insurance or prescription drug plan they offer, the cost-sharing tiers on which the medications are placed, and whether the drugs are non-narcotic or narcotic/opioids.

The probe is in response to an investigation published in September by The New York Times and ProPublica, which indicated that many insurers limit access to less-addictive pain medications while providing easier access to generic opioid medications—which tend to be cheaper but also carry a higher risk of dependence. 

The report also found that insurers have a more stringent approval process for addiction treatments than for the addictive substances themselves. 

“Insurers and PBMs have developed initiatives to address the opioid epidemic, but this new report indicates that fundamental financial incentives may be driving insurers and PBMs to steer beneficiaries to the very drugs that are fueling the opioid crisis,” Cummings said in a statement.

RELATED: Express Scripts to place new limits on opioid prescriptions, drawing criticism from AMA

Cummings isn’t the only official to put pressure on insurers.

During a meeting on Friday of President Donald Trump's Commission on Combating Drug Addiction and Opioid Crisis, former Democratic Congressman Patrick J. Kennedy took insurers to task about how they've covered behavioral health treatment in the past.

"The historic treatment of addiction and mental illness had been a separate and unequal process," he said. "All of you as insurers and payers have treated mental health and addiction as if it’s something other than the rest of medicine."

He also called for better and more consistent enforcement of the federal mental health parity law, noting that "some of the companies in this room" only removed prior authorization for medication-assisted treatment because New York's attorney general put them in a consent decree.

"The fact of the matter is that we shouldn’t be relying on one attorney general in one of the 50 states to enforce federal policy with respect to parity," Kennedy said.

Witnesses at the hearing included Anthem CEO Joseph Swedish, Kim Holland, is vice president, of state affairs, for the Blue Cross Blue Shield Association, and America's Health Insurance Plans President and CEO Marilyn Tavenner.

In September, attorneys general from 37 states sent a letter (PDF) to AHIP that urged its members to “encourage healthcare providers to prioritize non-opioid pain management options over opioid prescriptions for the treatment of chronic, noncancer pain.”

AHIP responded with a letter (PDF) outlining what insurers are doing to combat the opioid crisis, noting that “we share your belief that our industry and our members are key parts of the solution.”

And this week, the trade group launched an initiative dubbed Safe, Transparent Opioid Prescribing (STOP), which is designed to support widespread adoption of clinical guidelines for pain care and opioid prescribing. 

The initiative’s first action was to create the “STOP Measure,” which AHIP describes as an evidence-based methodology that health plans can use to measure how provider practices compare to the Centers for Disease Control and Prevention Guidelines for Prescribing Opioids for Chronic Pain.

Even before this new initiative, though, health insurers were taking steps to address the growing opioid crisis. 

Anthem, for example, announced in August that it had reduced the number of opioid prescriptions filled by its members by 30%—due in part to tweaks in its drug coverage policies. Cigna, meanwhile, said it would remove prior authorization restrictions for commercial plan members seeking medication-assisted treatment for opioid addiction—thus making it more accessible. 

And leaders from Blue Cross and Blue Shield plans recently described a variety of initiatives they’re undertaking to address the crisis, from using big data to predict members’ likelihood of developing an opioid addiction to holding community town halls to spread awareness.

Editor's note: This article has been updated to include information about the meeting of President Donald Trump's Commission on Combating Drug Addiction and Opioid Crisis.