Health Insurers Have Inconsistent Policy Terms for Non-drug Pain Treatments
Written by Editor   
Tuesday, April 16, 2019 08:05 PM

Public and private health insurance policies in the U.S. are missing important opportunities to encourage the use of non-drug alternatives to opioid medication for treating lower back pain, a study led by researchers at Johns Hopkins Bloomberg School of Public Health has found.

The researchers looked at Medicaid, Medicare and major commercial insurers' 2017 coverage policies for non-drug options for treating chronic lower back pain--a common pain condition that is often treated inappropriately with prescription opioids. They found that insurers have inconsistent policy terms for non-drug treatments, and provide little or no coverage for interventions which have some scientific backing.

“This study reveals an important opportunity for insurers to broaden and standardize their coverage of non-drug pain treatments to encourage their use as safer alternatives to opioids," says study senior author Caleb Alexander, MD, MS, associate professor of epidemiology at the Bloomberg School.

CDC officials estimate that 49,031 Americans died from opioid overdoses in the 12-month period ending in December 2017. In 2016, more than 40 percent of those deaths were due to prescription opioids. This epidemic has been encouraged by a several-fold increase in opioid prescriptions since the turn of the century--most of which are thought to be medically unnecessary. Current CDC guidelines note that "Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care." 

Even for physical therapy specific coverage policies were inconsistent. “Some plans covered two visits, some six, some 12; some allowed you to refer yourself for treatment, while others required referral by a doctor," Alexander says.  

The researchers interviewed 43 executives representing the evaluated plans; these individuals indicated that their organizations have been trying to expand access to non-drug therapies in response to the opioid epidemic. Overall, however, their remarks suggested that insurers were not yet doing enough to coordinate non-drug and drug coverage policies, such as requiring patients to try non-pharmaceutical interventions for lower back pain before covering long-term opioids.

Alexander emphasizes that many of the covered non-drug therapies, such as chiropractic, might seem untested, but there is significant evidence for their effectiveness in treating lower back pain.

The findings, to Alexander and colleagues, suggest that there is still a lot of room for improvement in coverage policies, particularly an expansion and standardization of non-drug treatment coverage and policy terms—a change that should encourage more use of non-drug treatments by patients before they resort to opioid painkillers.

“In the last few years we have seen many insurers modifying their policies to reduce the vast overuse of opioids, but clearly we still have a long way to go," says Alexander.


Source:  https://www.jhsph.edu/news/news-releases/2018/health-insurer-policies-may-discourage-use-of-non-opioid-alternatives-for-lower-back-pain.html