The Alliance for Patient Access / IfPA’s Patient Access Policy Blog / Medicare Coverage for Abuse-deterrent Opioids Dips, Despite Pills’ Effectiveness

Medicare Coverage for Abuse-deterrent Opioids Dips, Despite Pills’ Effectiveness

by Amanda Conschafter, blog editor

New research suggests that pain pills designed to deter abuse can in fact help curb prescription drug overdoses. So why does Medicare Part D coverage for these medications continue to decrease—despite prescription pain pill abuse among America’s seniors?

As a study from Avalere Health points out, Medicare coverage increasingly favors generic opioid pain pills without abuse-deterrent properties. The study found that Medicare coverage for all long-acting opioid pain medications fell from 46 percent in 2012 to 36 percent in 2015. For oxycodone with abuse-deterrent properties, coverage declined even more dramatically – from 61 percent in 2012 to 33 percent in 2014.

[Related: Abuse-Deterrent Opioid Formulations: Promising Technology, Unique Challenges]

Avalere Health’s study followed one brand-name form of oxycodone, which was labeled abuse deterrent by the Food and Drug Administration in 2013. The pill assumes a gel-like consistency if users attempt to crush or dissolve it, presumably for snorting or injecting. Since Avalere Health’s study period, three other opioid pain medications have also received abuse-deterrent labeling.

Higher costs for prescription opioids with abuse-deterrent properties pose challenges for both private and government insurers. Abuse-deterrent pills’ cost can be exponentially greater than the cost of a generic long-acting opioid without these properties.

At the same time, research suggests that abuse-deterrent technology can aid national efforts to curb prescription drug abuse, a public health priority. Thus, Medicare and other private and government insurers face an ongoing struggle: reconciling the limitations of their budget with the needs of the patients they cover.

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