Study Reveals Insurers Could Do More to Cover Opioid Alternatives

Heyward

A new study was recently conducted to better understand the landscape of coverage of non-pharmacologic treatments for chronic pain.

In the cross-sectional study of 45 Medicaid, commercial, and Medicare Advantage plans, most plans covered at least physical and occupational therapy and chiropractic care for chronic non-cancer pain, but there was little evidence of coverage of acupuncture and psychological interventions.

“We looked at coverage of five commonly prescribed non-pharmacologic treatments for chronic pain, including physical therapy, occupational therapy, chiropractic care, acupuncture, and therapeutic massage, as well as some additional therapies for Medicaid plans only” says study author Jamie Heyward, MPH, research data analyst at the Johns Hopkins Center for Drug Safety and Effectiveness. “We also interviewed 43 executives at those plans so we could understand their plans’ policy changes in response to the opioid epidemic, focusing on coverage of non-pharmacologic therapies.”

The study, published October 1, 2018 in the Journal of the American Medical Association (JAMA) Network Open, was conducted to better understand the landscape of coverage of non-pharmacologic treatments for chronic pain.

“Insurance coverage is an important factor in access to healthcare,” says Heyward. “There are recent guidelines from the CDC and HHS that recommend prescribing non-opioid and non-pharmacologic treatments rather than opioids for chronic pain. No studies have looked at whether insurance coverage policies help or hurt patient access to such treatments. We found that there is spotty coverage of several treatments that have evidence of effectiveness for treating pain, like acupuncture and psychological therapy.”

Most health plans the researchers examined cover therapies like physical and occupational therapy and chiropractic care, according to Heyward. “Even the commonly covered therapies are restricted by policies like visit limits, prior authorization requirements, and referral requirements, which may limit patient access,” he says.

The findings highlight the need for better coverage of alternatives to opioid painkillers for treating chronic pain. “Prescription opioids continue to play a large role in the high rates of addiction, overdose and death in the United States,” Heyward says.

“It is important that healthcare executives take steps to ensure their plans’ policies provide access to the full range of treatment options for patients with chronic pain,” adds Heyward. “This is especially important given the CDC’s opioid prescribing guidelines for doctors, as well other efforts to lower opioid prescribing levels. There is also growing evidence of the effectiveness of non-pharmacologic therapies for chronic pain.”

Other Unique Findings

Study researcher interviews revealed that most plans are making policy changes in response to the opioid epidemic. “However, these policies often focus narrowly on reducing opioid prescribing, rather than improving overall pain care through better coverage of alternative treatments,” Heyward says. “Also, coverage policies for pharmacologic and non-pharmacologic therapies for pain are not coordinated with each other.”

Based on the study, there are five things Heyward wants healthcare execs to know about insurer policies/non-opioid alternatives for pain:

• Plans almost always cover physical and occupational therapy as well as chiropractic care for chronic pain, but other evidence-based treatments are less commonly covered.
• “Our results suggest that plans could do a better job of increasing coverage of non-pharmacologic treatments for chronic pain, rather than focusing solely on reducing the overprescribing of opioids,” Heyward says.
• Inconsistent rules that limit access (visit limits, referral requirements, prior authorization, etc.) suggest a need for best practices for coverage and management of these treatments by insurance plans.
• Other aspects of coverage such as prescriber training, and network size, also will play a role in patient access to treatments.
• Plans are moving fast to improve coverage for pain patients, so some positive steps have already been taken.