Health Insurance Industry and Government Policies Create More Pain than Good

Health Professional

Now that we are a few weeks into this New Year, tell us how your medical insurance is working out for you?  Some of you might have noticed some formulary changes that have suddenly discontinued coverage on your medication.  Others of you might be wondering why your medication suddenly requires “prior authorization”.  And as this year progresses, your doctor may decide that you need a certain medication but your insurance refuses to pay for it.  Besides some of these insurance-related problems, the government is wrecking its own havoc by mandating limits in some states and forcing many doctors to stop prescribing opioid medications.  These policies created by the insurance industry and government are causing more pain than good.

In the interest of cost containment and profitability, the insurance industry has substantially limited access to opioid medications that not only provide better pain relief, but also prevent substance abuse.  These tamper-resistant/abuse-deterrent formulations are much more expensive than plain hydrocodone or oxycodone; thus, it is much easier to get a prescription for hydrocodone than it is for tamper-resistant brands like OxyContin, Exalgo, and Suboxone.  Not only do these brands help to deter abuse, these particular brands provide better, more sustained pain control because of extended-release or longer-action of the chemical.  Since hydrocodone, hydromorphone and oxycodone are so much easier to fill at the pharmacies, doctors are much more likely to prescribe them despite the risks of abuse and worsening pain in the form of opioid-induced hyperalgesia.  These medication policies that are driven by cost-containment actually lead to more prescription drug abuse than people realize.

The insurance industry also perpetuates pain by limiting access to interdisciplinary team approaches and alternative approaches.  These treatment strategies actually strive to reduce the overall use of opioid medications.  However, if you are not allowed to visit a physical therapist, a psychologist, a chiropractor or an acupuncturist, then you are more likely to rely on opioid medications alone and more likely to experience chronic pain.

So what is the government doing to help ease your pain?  Nothing really, its main focus seems to be to eliminate the use of opioid medications altogether in a prohibition-style manner in order to solve the opioid abuse problem.  State mandated efforts to limit the amounts of opioids prescribed are done in terms of morphine equivalent daily dosages.  For example, if you are in Minnesota, you are only allowed 120 Morphine Equivalents per Day (MED).  Interestingly, the Canadian neighbors to the north are allowed 200 MED.  Regardless about whether or not these limits make sense or are evidence based, insurance companies love this approach because it is a great way to contain costs.  Now, many doctors are simply refusing to prescribe opioids because of the increased amount of scrutiny from the insurance industry and the government.

These flawed policies will not eliminate the epidemic of opioid abuse just like prohibition did not prevent alcoholism.  These policies are only improving the profits of the insurance companies, and worsening the epidemic of chronic pain.  If the government really wanted to limit the use of opioids, it would mandate insurance companies to pay for more ancillary care of those experiencing painful conditions.  More physical therapy, more acupuncture, more massage therapy and other ways to treat pain without a medications is what people experiencing pain really need in order to use less drugs.  A nationwide revival of interdisciplinary teams to treat pain is a solution that makes the more sense than allowing fear and profits to dictate treatment methodology.


Schatman, Michael; Webster, Lynn; The Health Insurance Industry: Perpetuating the Opioid Crisis through policies of cost containment and profitability;  Journal of Pain Research; 2015; 8: 153-158

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