Trump commission seeks insurer buy-in toward combating the opioid crisis

Former congressman Patrick Kennedy on Friday did not mince words when talking to health insurers about the way he felt the industry has hindered efforts to combat the opioid crisis.

"The historic treatment of addiction and mental illness has been a separate and unequal process," Kennedy said during the most recent meeting of President Donald Trump's opioid commission. "All of you as insurers and payers have treated mental health and addiction as if it was something different from the rest of medicine."

Kennedy blamed insurers for creating disparities in the way mental health and substance abuse treatment have been covered compared to that of physical health. He stressed the need for stronger regulatory oversight to make sure insurers had some level of accountability to ensure greater parity between mental and physical health.

Representatives of insurers Aetna, Cigna, Anthem, UnitedHealth Group, Kaiser Permanente, and Blue Cross Blue Shield attempted to outline some of the positive moves they have taken to address the problem of opioid abuse among their members.

Such moves have included most of the large companies committing to eliminate prior authorization for medication-assisted treatment, which addiction treatment advocates have argued served as a barrier to access for many patients.

But Kennedy did not appear to be impressed, saying some insurers have taken such actions out of necessity rather than for altruistic reasons. He cited insurers like Cigna and Anthem were simply following the orders of consent decrees made with the New York State Attorney General's Office over the past year as the reason for them ending prior authorization of MAT.

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

The fourth meeting of the commission comes a little more than a week before the group is expected to release its final report of its findings and recommendations on effective solutions the federal government can pursue to address the crisis.

"Sixty-four thousand deaths in the United States from a crisis that has been, in my view, self-inflicted," said New Jersey Gov. Chris Christie, chair of the commission. Christie was referencing government estimates of the total number drug overdose deaths that occurred in 2016."If we had 64,000 Americans being killed in some other way, I think that the reaction would have been significantly different than it has been."

Representatives from most of the country's largest health insurance companies testified before the commission to share what they have been doing to combat the problem.

"We all agree there's not just one solution to the problem," said Marilyn Tavenner, president and CEO of leading industry trade group, America's Health Insurance Plans, in prepared remarks before the panel. "It's going to take a multi-faceted approach."

Tavenner mentioned the launch this week of a new AHIP campaign to promote greater transparency in opioid prescribing called the Safe, Transparent Opioid Prescribing, or STOP Initiative. One of the campaign's first actions is to provide a methodology that health plans can use to measure if provider prescribing practices are complying with Centers for Disease Control and Prevention guidelines issued last year.

A number of insurers have taken steps on their own to limit patient exposure to opioids. Some have reduced the number of days' supply it will pay for of a single prescription of opioid pain relievers. Earlier this month, Cigna Corp., announced plans to end its coverage for the pain medication Oxycontin by next year. Most of the large companies have also committed to eliminating prior authorization for medication-assisted treatment, which addiction treatment advocates have argued served as a barrier to access for many patients.

But insurers have largely taken such actions just over the past year, as the industry has increasingly come under fire for not doing enough to address opioid abuse.

Addiction medicine advocates and lawmakers have alleged health insurers share culpability in making the problem worse by adopting policies that many believe have promoted the use of cheaper, more addictive opioid-based pain relievers rather than less addictive, but more expensive, pain-relieving alternatives.

On Thursday, Rep. Elijah Cummings (D-Md.) wrote a letter to companies UnitedHealth Group, Humana, Optum, Anthem and Aetna in response to a recent investigative report that found insurers had limited access to pain medications that carried lower risks of addiction.

A Modern Healthcare special report published in April found health insurers continued to put up barriers that made it difficult for patients to access medication-assisted treatment. Kennedy urged insurers to take the same level of urgency in providing patients with access to that treatment as they would when responding to a natural disaster.

"We ought to be treating this like a FEMA response and getting the necessary medication," Kennedy said. "If this were Ebola, we would be getting it out there to every practitioner in the country."

The work of the commission may have to be accelerated in light of the news that Trump plans to formally declare the opioid crisis a national emergency early next week, even as the commission continue to put the final touches on its final report scheduled to be released Nov. 1.