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.
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.