Payers are grappling with their responses to the opioid crisis. Support for their moves isn’t unanimous.
One of the largest health insurance companies in the U.S. announced new steps Tuesday to combat the opioid epidemic by imposing stricter prescription limits and waiving copays for the overdose-reversing nasal spray Narcan.
Aetna says the changes, which will take effect on New Year’s Day, will remove financial hurdles that currently keep some Americans from accessing and using the life-saving drug.
“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” Harold L. Paz, MD, MS, executive vice president and CMO for Aetna, said Tuesday in a statement. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”
Members currently make copayments ranging from $0 to $150 for Narcan, with the average typically landing between $30 and $40, the company says. Those with higher copays have been less likely to fill their Narcan prescriptions.
During the first six months of the year, more than three-quarters (76.7%) of Aetna members with copays above $100 for Narcan didn’t pick up their prescriptions, the company says, citing claims data from IMS Health. This abandonment rate was much lower (46.1%) for Aetna members with copays between $40.01 and $50.
A company spokesperson tells HealthLeaders Media the copay waiver will apply to Aetna’s 4.6 million fully-insured commercial members. That excludes about 13.5 million self-insured medical members, whose copay structure will continue to reflect the current ranges unless and until their self-insured employers decide to incorporate the Narcan copay waiver into their benefits plans, the spokesperson says.
Thom Duddy, spokesperson for Narcan manufacturer ADAPT Pharma, says the company’s pricing model has been transparent and consistent since its launch last year.
“We’ve never raised our price,” Duddy says.
Across all payers, more than a third of prescriptions for the nasal spray already enjoy a $0 copay, according to the company. Nearly 80% of the prescriptions have a copay of $20 or less.
Praise & Criticism
Leo Beletsky, JD, MPH, an associate professor of law and health sciences at Northeastern University in Boston, praises Aetna’s effort to make naloxone (the active drug in Narcan) more affordable.
“It is unconscionable that in the middle of a public health emergency, we still have numerous barriers to accessing this lifesaving medication,” Beletsky writes in an email.
Beletsky is less than pleased, however, by the other initiative Aetna announced Tuesday. The company says it will limit opioid prescriptions to a seven-day supply for its 8 million commercial pharmacy members, when members experience acute pain or recover from surgery—a move Beletsky says could do more harm than good.
“Research suggests that needs for post-operative opioid use are highly varied, depending on the procedure and the patient. Those modal needs vary from 3 to 14 days,” Beletsky writes. “I agree that we need to moderate opioid prescribing to align it more closely with what is necessary and appropriate, but across-the-board mandates and limitations of this sort are not driven by evidence and can be counterproductive.”
Steven Porter is editor at HealthLeaders.