Opioid addiction related insurance claims rose by 3,204% from 2007 to 2014

(AMA Morning Rounds, 8/2/16) –  On its website, CNBC (8/1, Mangan) reports a new analysis conducted by FAIR Health found that healthcare claims for people addicted to prescription pain medications “and heroin skyrocketed as the number of Americans who fatally overdosed on those opioids hit record highs.” Data show the number of such claims rose by 3,204 percent from 2007 to 2014. The analysis also revealed “other disturbingly sharp spikes upwards in the number of private insurance claims related to opioid abuse, drug dependence by pregnant women and heroin overdoses since 2011.”

The NPR (8/1, Appleby) “Shots” blog publishes a Kaiser Health News article which says that in order to conduct the analysis, researchers examined “de-identified claims data from insurers representing 150 million patients who either have insurance through work or buy coverage on their own.” They focused on “diagnosis codes related to opioid dependency and abuse, adverse effects of heroin use or problems caused by the misuse or abuse of other types of opiates, including prescription drugs,” and found a marked increase, particularly since 2011. The data also reveal that patients aged “19 to 35 were most likely to be diagnosed as opioid dependent.”

AMA chairwoman urges insurers to expand coverage for opioid addiction Patrice A. Harris, MD, chairwoman of the American Medical Association, writes in a letter to the editor of the Hartford (CT) Courant (8/1) that the AMA concurs “with Aetna medical officer Dr. Mark Friedlander that we need to increase access to medication-assisted treatment for patients with substance use disorders.” She says the AMA is also urging “Aetna, Cigna and all other payers in Connecticut to remove barriers to evidence-based care, including limits on physical therapy, cognitive behavioral therapy, psychiatric care and other multimodal therapies that may be appropriate.” Harris adds that in order to effectively combat the opioid epidemic, “physicians must continue to play an active role in treating our patients using evidence-based care, and that also means insurance policies must provide our patients with the benefits, coverage and access necessary for that care.”

For more information about preventing opioid abuse, visit this AMA resource guide.