Drug addiction treatments in peril

Facing Pressure, Insurance Plans Loosen Rules For Covering Addiction Treatment, But That Could Reverse Itself

Aetna, one of the nation’s largest insurance companies, will remove a key barrier for patients seeking medication to treat opioid addiction. The change will take effect in March and apply to commercial plans, a company spokeswoman confirmed, and will make it the third major insurer to make the switch.

Specifically, Aetna will stop requiring doctors seek approval before prescribing particular medications ― such as Suboxone ― that are used to mitigate withdrawal symptoms, and typically given along with steady counseling. The insurance practice, called “prior authorization,” can result in delays of hours to days in getting a prescription filled.

The change comes as addiction to opioids, which include heavy-duty painkillers and heroin, still sweeps the country. More than 33,000 people died from overdosing on these drugs in 2015, the most recent year for which statistics are available. And it puts Aetna in the company of Anthem and Cigna, which both recently dropped the prior authorization requirement for privately insured patients across the country. Anthem made the switch in January and Cigna this past fall.

Both companies took the step after facing investigation with New York’s attorney general, whose office was probing whether their coverage practices unfairly barred patients from needed treatment. They made this adjustment as part of larger settlements.

It sounds like just a technicality ― a brief delay before treatment. But addiction specialists say this red tape puts people’s ability to get well at risk. It gives them a window of time to change their minds or go into withdrawal symptoms, causing them to relapse.

“If someone shows up in your office and says, ‘I’m ready,’ and you can make it happen right then and there ― that’s great. If you say, ‘Come back tomorrow, or Thursday, or next week,’ there’s a good chance they’re not coming back,” said Josiah Rich, a professor of medicine and epidemiology at Brown University and doctor at Providence-based Miriam Hospital, who frequently treats patients with opioid addictions. “Those windows of opportunity present themselves. But they open and close.”

As these major carriers drop the requirement, treatment specialists hope a trend could be emerging in which these addiction meds become more easily available. In New York, for instance, the attorney general’s office will be following up with other carriers who still have prior authorization requirements, an office spokesperson said. The office would not specify which carriers it will next examine.

Meanwhile, though little research pinpoints precisely how widespread this coverage practice is for drugs that treat opioid addiction, experts say it’s a fairly common practice.

“Just think of any big health insurance company that hasn’t recently announced they’re doing away with this, and it’s a pretty safe bet they’ve got prior authorization in place,” said Andrew Kolodny, a Brandeis University senior scientist and the executive director of Physicians for Responsible Opioid Prescribing, an advocacy group.

Aetna will stop requiring doctors seek approval before prescribing particular medications such as Suboxone. (Wikimedia Commons)

How does the problem manifest? Take Boston Medical Center, located in a region that’s been particularly hard hit by opioid addiction. Doctors there wanted to launch an urgent care center focused on this patient population. Less than a year old, the program’s treated thousands of people.

But prior authorization requirements have been intense, said Traci Green, an associate professor at Boston University’s School of Medicine and deputy director of the hospital’s injury prevention center. To help people get needed care ― before it was too late ― the center hired a staffer devoted specifically to filling out all the related insurance paperwork.

“It was like, ‘This is insanity,’” Green said, adding that “navigating the insurance was a huge problem” for almost every patient.

But defenders of the requirement maintain that such controls have value. Insurance plans using prior authorization may view it as a safeguard when prescribing a potentially dangerous drug. “[It’s] not a tool to limit access. It’s a tool to ensure patients get the right care,” said Susan Cantrell, CEO of the Academy of Managed Care Pharmacy, a trade group.

Other large insurance carriers ― such as United Healthcare and Humana ― list on their drug formularies a prior authorization requirement for at least some if not all versions of anti-addiction medication. A spokesperson from Humana said the practice is used “to ensure appropriate use.”

Also, though, it is generally agreed that the practice is used to control the prescribing of expensive medications. Per dose, the cost of these drugs varies based on brand and precise formulation, but it can go as high as almost $500 for a 60-pack dose, which can last a month.

Regardless of intent, critics say, those extra forms and hoops do make it more difficult for patients in need to get these medications ― ultimately, they say, doing more harm than good.

“If you would like a physician to not do a particular treatment, put a prior authorization in front of it,” Rich said. “That’s what they’re used for.”

Meanwhile, addiction treatment advocates and health professionals are hoping to build on what they see as new momentum.

Earlier this month, the American Medical Association sent a letter to the National Association of Attorneys General, calling for increased attention to insurance plans that require prior authorization for Suboxone or other similar drugs.

Minnesota’s attorney general has written to health plans in the state, asking they end prior authorization for addiction treatment. New York has also heard from other states interested in tackling the issue, the attorney general spokesperson said. And another project, called Parity Track, is soliciting complaints from consumers.

They’re arguing based on a requirement that insurance plans, thanks to so-called “parity laws,” must cover addiction treatment, and cover it at the same level as they do other kinds of health care.

The prior authorization requirement “doesn’t meet the sniff test for parity,” said Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee. “It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. Every other disease with a known mortality ― the first-line drugs are available right away.”

But the justification for legal cases like New York’s could get weaker. The 2010 health law, which lawmakers are working to repeal, included requirements that mental health and addiction treatment be considered an “essential health benefit.” If that disappears, robust coverage for addiction could be less widely available, several noted.

Meanwhile, the stakes are substantial, Rich said. He recalled a patient who was taking a version of buprenorphine ― the active ingredient in Suboxone ― who had a brief relapse with heroin. That led to complications in the paperwork for renewing his prescription for treatment.

“Now he’s out of the office, in the street, using more,” Rich said of that case. “Incumbent upon [effective treatment] is the ability to get people started right away. If there’s prior authorization? It’s infuriating.”

Dog mysteries: puddles vs. poo

Some things Otto does make no sense. But they don’t have to because he’s a dog. And we love them anyway, right?

The best Sweden meme I’ve seen

 

#StandWithSweden

Milo discovers Breitbart’s breaking point?

Milo Yiannopoulos
  • Racism.
  • Sexism.
  • Misogyny.
  • White Supremacy.
  • Too many others to name.

Of all the horrors and anti-social, anti-democratic behaviors which can be laid at the doorstep of the alt-right web site Breitbart, there appears to be one they cannot tolerate:

All is not well at Breitbart News.

A senior editor at the right-wing publication tells Washingtonian that “at least a half-dozen” employees are prepared to leave the company if Milo Yiannopoulos is not promptly fired. A second Breitbart source confirms this estimate.

Yiannopoulos, himself a senior editor at Breitbart, was booted from his speaking slot at this week’s Conservative Political Action Convention (CPAC), following taped revelations in which he appears to endorse pedophilia.

I figured Milo’s time as the gay court jester of the alt-right was limited. Also, his big book deal has been cancelled.

Milo is a pig. Beyond being, apparently, an alleged defender of pedophilia.

Otto graduates to his harness for walks

Otto in harness
Otto (and his ever-present tongue)  looking great in his red-and-black harness, which he now seems to able to use on walks no problem.

(Another in a series on my life as a first-time owner of a rescue pit bull.)

When I first adopted Otto from Chicago Animal Care and Control (CACC), the Chicago municipal shelter, I bought a harness for him and it turned out to be a bit of disaster on walks.

Otto was a problem dog on walks. He was not socialized well. He lunged at everything. Other dogs. Adults. And, most frightfully, little children. He was also a terrible ambassador for pit bulls, only reinforcing in the minds of all we met on his walks that pit bulls were scary dogs. (Any dog can be scary if they are not socialized well, BTW.)

I thought a harness would give me more control and calm him down, but that is not the way the harness worked in the real world. Just as with a plain old collar, Otto pulled and tugged and struggled to get at other people and dogs while wearing a harness. The harness gave me some measure of control over him which exceeded a plain collar, but did not seem to lessen the lunging behavior. Its advantage over a choke collar seemed to be only that: he was not choking himself while lunging. But walks were still a headache for Otto and me, and scary for my neighbors.

Reluctantly, I considered a training collar, which is a collar with (in my case) smooth plastic teeth which face a dog’s neck. So while the collar is designed not to close past a certain point so as to choke a dog, the teeth do dig into a dog’s neck if they pull too hard. Some “dog people” oppose them reflexively. But if you have a dog with whom you lose control because of aggressive behavior, you run the risk of that dog being labeled as vicious (or worse) and the authorities in Chicago will take that dog away.

So I tried a training collar that a friend gave me.

It worked. And it’s been working since I first put it on him. After a short time he adjusted to it and just never pulled past a certain point. Otto started to find his equilibrium on walks. He still pulled, but pulled less all the time. 

Today, five months later, I decided to switch Otto’s training collar for that harness I bought. We went on our longest walk ever.

He was great. Never lunged one time at anyone and walked in the same relaxed, controlled manner that he showed when he had been walking with the training collar.

An added thing to celebrate: when I first adopted Otto he was so skinny! Life in a shelter did not agree with him, I suspect because he was not getting the 24-hour loving he craves so much. The harness I bought was too loose even when it was adjusted to its smallest size.

Today the harness fit perfectly (as you can see from the above photo) and my little voracious eater has grown so much I hadn’t even noticed until I put the formerly too loose harness on him. In fact, I may need to buy a harness a size larger as he is almost to the point of outgrowing this one.

Patience and consistency in training. Those are the keys to life with a happy, loving pit bull. 

Keep at it. Don’t give up. If I can do it, you can, too.

The training collar I used for Otto, given to me by a friend. Click on the pic to go to the page where you can buy one.

“Funny you should ask about those, Aunt Martha”

Bring these to your next family gathering for a fun and delicious way of telling everyone you’re a gay man.

Froot Loops, indeed.

#Respect #MassExtinction #CretaceousPaleogene

#NeverForget

An “I feel lost” pick-me-up

When I feel overwhelmed by the Trump disaster, I watch this and think of how someone took the time to make us laugh with this GIF of him and a rainbow dick.

Someone call Pat Robertson!

Hey llama! God’ll getcha for that!

He’d wring his gnarly hands and show his gnarly frown because this goes totally against God’s will. Against nature!

I like the guy’s dry narration on this video.

The video is not new, but is amusing nonetheless.

Also it has a llama AND a cow, two of my favorite animals.

The cow reacts like I react to sex these days: “OK OK! Go ahead. But could you hurry up? You’re annoying me. Also, I have Zumba in 20 minutes.”

Thought for the day

Via @CharlesPPierce, writer for Esquire and one of the smartest guys in journalism.

Just because you want to be informed doesn't mean you can't laugh along the way. Science, politics, religion, pop culture and the law.