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As opioid crisis continues, doctors say insurance companies are rejecting other options

FILE - This Feb. 19, 2013, file photo shows pills of the painkiller hydrocodone at a pharmacy in Montpelier, Vt. Drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia in just six years, a period when 1,728 people fatally overdosed on these two painkillers, according to an investigation by the Charleston Gazette-Mail. (AP Photo/Toby Talbot, File)

The battle against the opioid crisis is a vicious cycle being fought in towns and cities across the country and right here in central Ohio.

Communities are in the grips of a problem destroying thousands of lives and families. Drug companies and doctors taking the brunt of the criticism, but a local doctor reaching out to ABC 6/FOX 28 with major concerns.

Doctors and some patients tell ABC 6/FOX 28, a large part of this issue all boils down to money. They claim it’s putting a lot of people with serious conditions at risk.

Dr. Kedar Deshpande, revealing page after page of insurance denial letters. The list of companies is long.

"Aetna, My Care Ohio, Anthem Blue Cross Blue Shield, the Buckeye Health Plan, Caresource, Humana, Medicare, Medical Mutual," said Dr. Deshpande.

The list goes on and on. Dr. Deshpande told ABC 6/FOX 28 patients at the Orthopaedic and Spine Center in Dublin are receiving limited access to pain meds carrying a lower risk of addiction or dependence.

"Before I use a safe abuse deterrent medication, they want me to use a fentanyl patch, methadone, methadose, generic morphine, oxymorphone ER. Oxymorphone is the medication that was called Opana ER that was recently pulled off of the market by the government because it was killing people," said Dr. Deshpande.

Dr. Deshpande said insurance companies mandate the medications physicians can and can’t prescribe, based on “medical necessity” guidelines.

"These medicines that I listed are so much stronger than the ones that we want to prescribe that are safer. These cause a physical dependency very quickly in patients and then trying to stop these medicines is extremely painful and extremely difficult for the patient to come off of these medicines," said Dr. Deshpande.

At the same time, Dr. Deshpande stressed that insurers are providing easy access to generic opioid medications.

"It puts the physicians in a very difficult position because on one end, we're being watched, we're being monitored on what type of medications we're writing, how much we're writing and what we're writing them for. And on the other end, we want to write what's safe for our patients, but we can't," said Dr. Deshpande.

As the fight over the opioid crisis in central Ohio rages, doctors along with pharmaceutical companies have taken a number of critical hits. A brighter light now shining on insurance companies as well.

“There’s plenty of blame to go around for the opioid crisis,” said Democratic U.S. Senator Sherrod Brown.

Brown is at the forefront of the battle to stop the problem.

“To fight an epidemic like this, to fight one of the worst public health crises our country’s had in recent years you need all hands on deck,” said Brown.

Brown told ABC 6/FOX 28 that lawmakers need input from all involved to really make an impact.

“We need the insurance companies and the doctors and the drug companies themselves to sit down and really work out what’s the best public policy,” said Brown.

We spoke with a patient facing an uphill battle in her treatment. She said that after 2 years her insurance company stopped coverage on a pain patch she was using that doctors indicated to her was less addictive. For privacy, she wanted to keep her identity concealed. However, she believes her story needs to be told.

"They gave me a choice of 5 different medications, one being fentanyl, the other ones were some form of morphine. They said I had to put an appeal in and that I had to try one of those drugs for one month before they would even consider giving me back the previous patch I was on," the patient said.

ABC 6 reached out to a number of insurance companies for comment on these claims.

Anthem released information in August of 2017 stating the company is working to limit access to opioids. In a press release listed on the company’s website stating in part, “Prescribed opioids for members of Anthem Blue Cross and Blue Shield in Ohio have dropped by 16-percent. The primary goal of the quantity limits was to prevent inadvertent addiction and opioid use disorder."

In a statement to ABC 6/FOX 28, Anthem said "The opioid epidemic has evolved into a public health crisis, and the problem in Ohio is growing. Anthem is responding to this epidemic through a three pillar strategy focusing on prevention, treatment and deterrence. Anthem’s goal is to ensure the appropriate use of all prescribed opioid medications that have clinical evidence demonstrating that the medications are safe and effective; resulting in improved health for our members. Some of the steps we are taking to achieve this goal are limiting coverage of opioids to seven days to those newly starting opioids, directing those most at risk for opioid use disorder to one pharmacy and requiring provider prior authorization. Additionally, there are many non-opioid approaches to pain relief that Anthem covers. Through our actions we have made significant progress to help ensure appropriate use of opioids and have reduced opioid prescriptions amongst our members in Ohio by 16 percent in the past year."

Aetna released a statement that said in part, “Aetna has a number of different initiatives intended to address opioid addiction and use among our members. Aetna is focused on three pillars: prevention, intervention and support. encouraging appropriate prescribing is a large part of our work.

Dr. Deshpande told ABC 6/FOX 28 that he believes more still needs to be done.

"This is happening all over the country, all over our state," said Dr. Deshpande.

The finger he said has been pointing for far too long at doctors and drug makers. As he sees it, lives are on the line.

"This is a problem in our society. It's a problem that's fueling the opioid epidemic," said Dr. Deshpande.

The issue is getting major attention. This year, President Donald Trump’s “Opioid Commission” turning its attention to the role health insurance policies might be playing in this addiction crisis. The group has indicated new demands could be put in place to ensure companies are not profiting while in the process allowing an epidemic of addiction to grow.


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