Judy Foreman: Blue Cross Painkiller Policy Risks Hurting Patients

Health columnist Judy Foreman

The state’s largest insurer has just unveiled a plan aimed at stemming abuse of painkillers, a major national problem. The Boston Globe writes about the new policy here, and today’s Radio Boston show focused on it as well, featuring Dr. Lynda Young, Mass. Medical Society president, and Dr. John Fallon, chief physician executive at Blue Cross Blue Shield.

Syndicated columnist Judy Foreman, author of an upcoming book about chronic pain — “A Nation in Pain: Healing Our Biggest Health Problem” – comments:

By Judy Foreman
Guest Blogger

It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it.

But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15– day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications.

There’s no question that a few physicians prescribe too many opioids and a few patients scam their doctors for more. But the far larger problem is under-treatment of the pain of 100 million Americans, some of whom appropriately need opioid medications.

Blue Cross’ new policy, while it may stem from legitimate, benign motivation, could end up making the lives of pain patients more difficult than they already are. Blue Cross is concerned about “doctor-shopping,” that is, patients going from doctor to doctor to get drugs in order to abuse them. But the truth is that many legitimate pain patients go from doctor to doctor not to abuse drugs but to find someone who understands and can treat their pain.

As for the concern that people who fill opioid prescriptions wind up with medicine cabinets full of left-over pills?

That’s absolutely true. In fact, according to federal government figures, that’s where most of the drugs that get diverted to street users come from. But the federal government has a totally inadequate policy for solving this.

The Drug Enforcement Administration designates on day a year (this year it was April 28) as “take-back” day (actually four hours, from 10 a.m. to 2 p.m.) during which people can take their unwanted drugs to disposal sites.

Driving the hysteria about opioid abuse is the fear of addiction. But even with long-term use, the risk of addiction is far short of the 100 percent that the public seems to think. The risk of addiction is estimated to be between 4 and 26 percent, and that’s according to a conservative group, the Physicians for Responsible Opioid Prescribing.

There’s another root cause at play here. Basically, though most people haven’t digested it yet, the “war on drugs” has failed.

That’s not my conclusion. It’s the conclusion, issued in June, 2011, of the Global Commission on Drug Policy, a group that included former heads of state, Kofi Annan (the former Secretary-General of the United Nations), Paul Volker (former chairman of the Federal Reserve), George P. Shultz (former US Secretary of State) and others.

“The global war on drugs has failed,” said the group, “with devastating consequences for individuals and societies around the world….Arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”

Blue Cross’ new policy may end up being benign. But it smacks of the old war on drugs mentality. And if it plays out that way, it could end up hurting pain patients.

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  • Elinor Leal

    WHILE THERE IS WAY TOO MUCH TO SAY ON THIS SUBJECT … I am completely horrified at this ( very well stated ) ” Benign Motivation ” of BCBS … The Bottom Line is: IT IS NOT THE INSURANCE PROVIDERS PLACE TO COME BETWEEN DOCTOR & PATIENT … PERIOD. This action and others that may echo this in the future should NEVER BE ALLOWED IN ANY WAY, SENSE, SHAPE OR FORM.. This “IS” an injustice to the Insurance Customers/Patients, who are paying premiums in order to have ease from the cost to pay for Doctors & Prescriptions. That’s it , they do not want your input or advice or directives regarding how much medication they should get or at what intervals.. Thank You for your time !!

  • nukeo.com

    I wonder how much the internet is to blame. Is buying hydrocodone really as easy as being referred to an understanding doctor through findrxonline, or searching at pharmaspider for a prescription drug so it can be ordered from the convenience of home?

    • Don 1

      Has nothing to with it whatsoever, It’s a seperate item entirely. These items  don’t go thru tour health plan  so this won’t stop them

  • Kimmel

    I wonder if Don 1’s doctor might be confused about state requirements for patients on chronic opioid treatment. Unless the rules have undergone a recent change, the state of Massachusetts asks that such patients check in with the doctor quarterly, or once every three ( 3 ) months. To my knowledge, there is no requirement for a face-to-face appointment every month and certainly, no mandate to see the doctor every two weeks! It is true, however, that all schedule 2 opioid prescriptions must be written as new every month, and that the patient must come to the office, usually in person, to pick the prescriptions up. It’s a rare patient who would put up with the welter of do’s and dont’s required by ongoing opioid treatment, unless severe chronic pain forced them to do so. I am distressed to hear that a large and highly respected insurance company is choosing to make a proven, effective treatment more difficult than ever for a large number of highly vulnerable people — not to mention their physicians — a relatively small group that is courageous, but still unnerved.

    is true, however, that no schedule 2 opioid prescription is refillable. The patient must show up at the office, monthly, to pick up a new prescription

    • Don 1

      Clinic Guidlines! We don’t live in Mass, but am concerned this could done elsewhere,

  • Judy

    Dr. Fallon, thanks for your thoughtful response. I can’t wait for you to read my book! Judy

  • Dr. John Fallon

    Judy – I’ve been a great fan of your reporting for years, but I’d like to add a couple of points to give your readers a fuller picture of the problem and the policy we announced yesterday.

    |First, there is nothing in our policy that will prevent any of our members from getting the pain treatment that they need, and we’ve made it easy for doctors to provide that treatment.  That is true today and it will be true after July 1 when the plan is implemented. We developed our new policy with a panel of outside experts in pain management, primary care and addiction.  Our focus was on assuring that patients who need these medications receive them and, at the same time, for those starting new prescriptions that there is some assessment of the quantity prescribed.  In our pharmacy data only a small percentage of new prescriptions will need more than a 30 day supply.  And, during the 18 months that we developed this plan, one of our top priorities was to protect vulnerable patients. For those on chronic medications, the doctor will only have to renew once a year, verifying the need and assuring national best practices are being followed for managing chronic narcotic prescribing.  We have also made special accommodations to avoid impacting the care of patients with cancer, and those at the end of life.

    Secondly, the public health problem of painkiller misuse, dependency and diversion is not based on hysteria, it is real. One need look no further than this blog to read a compelling story of a WBUR producer, Keosha Johnson, who shared her experience taking these medications.   The CDC considers prescription drug abuse the fastest growing drug problem in the United States.  The agency has characterized prescription drug overdoses as an epidemic, with one death every 19 minutes.  Locally, Mass. DPH has reported that the number of Schedule II painkiller prescriptions has doubled in the past decade alone.  While DPH acknowledges importance of treating pain – as do we — they also say that the volume of the medications being prescribed can pose a risk to communities.

    On a recent 60 Minutes episode, the director of the National Institute on Drug Abuse said that last year in the U.S. there were 210 million prescriptions for opiate medications.  That’s 210 million prescriptions, in one year, in a nation of 311 million people.

    These are respected agencies that are not given to hysterical pronouncements. They see the data, they see problem and they have called for a more robust public health response.  CDC’s call to action includes health plans and we believe we have a role to play in making sure our members get the highest quality of care possible.

    Finally, your description of our policy as driven by a “war on drugs mentality” is not correct.  On the contrary, this is a thoughtful plan that takes a balanced approach, recognizing the need to treat pain while at the same time promoting an evidence-based approach to prescribing narcotic pain medication.  It’s a plan which puts patients first and ensures that they are fully aware of the benefits and the risks involved with prolonged use of prescription painkillers.

    Thanks for writing on this topic.


    Dr. John Fallon
    Chief Physician Executive
    Blue Cross Blue Shield of Massachusetts

    • Judy

      Dr. Fallon, thanks for your thoughtful response. I can’t wait for you to read my book! Judy

  • Don 1

    Dear Sir,  while theire may have been 210 million prescrpitions written last year, how many were for a handful, for  someone who just had surgery  major/and or Minor. Persons with Chronic pain already have to to step thru hoops  to get prescriptions filled.  If your worried about a DR meeting certain standards, then let that be his criteria for being in the network. People on Chronic pain meds can’t get mail order as it stands right now, they are required to Go for a Doctors appointment  once a month. They don’t refhill over the phone. How about doing something to help keep the costs down other than doubling the co-pays.

  • Don 1

    This is really an insult to people with pain issues!  As it stands right now my spouse has been disabled with pain issues for over 5 years. Because of these old tjired War on Drugs thinking she has to see her Doctor every month, have an annual Drug Screening test. No refills over the phone, no refills period with out an appointment. So now we have to go to the Doctor every 2 weeks. Yeah we want to control cost.

    • malcolmkyle

      Try marijuana!