The problem of opiate addiction in Maine is one that state Rep. Barry Hobbins knows something about. "One of my family members has been struggling with this dreaded addiction of opiates for six years," he says.
So when pharmaceutical company Pfizer — which makes opioids that have abuse-deterrent properties — asked Hobbins to sponsor a bill that would require insurance companies to cover these more expensive drugs at the same level as other opioids, he agreed.
Abuse-deterrent opioids are designed to be harder to crush, cut, or dissolve. Some transform into a gel when mixed with water, so are harder to inject than versions that readily dissolve. "The bill that I sponsored was, I think, one step to address the problem that we have," Hobbins says.
Last year, Massachusetts became the first in the nation to pass a similar law, which will take effect this October. This year, states from Vermont to California may follow suit.
Some physicians say such legislation is well-meant, but question how much of a dent it will put in the addiction problem. Insurance companies, meanwhile, say that if the bill becomes law, it will only drive up the cost of monthly premiums for all policyholders.
Hobbins' bill initially sought to require insurance companies to cover all abuse-deterrent opioids as "preferred drugs." It's been amended to allow insurance companies to choose whether or not to cover the more expensive opioids. If they do, the co-pay level that patients pay must be the same as for traditional versions of the pain pills.
But there are only three prescription opioids approved as abuse-deterrent by the FDA, and they're all name brands, says Katherine Pelletreau, executive director of the Maine Association of Health Plans, which represents four insurance carriers.
"We have concerns about requiring that a name brand drug — which can be significantly more expensive — be subject to the same cost-shares as a generic," Pelletreau says. Tamper-resistant opioids can cost hundreds of dollars more than versions of opioids that don't have those properties.
Some doctors aren't keen about Maine's bill, either. Dr. Mark Publicker, a psychiatrist and past-president of the Northern New England Society of Addiction Medicine, says the bill has good intentions, but "I'm not sure it's going to have the desired impact."
These new opioids are not abuse-proof, Publicker says. An HIV outbreak in Indiana has been linked to the opioid drug Opana, which, Publicker points out, "is alleged to be tamper-resistant, and people with opiate addiction fairly quickly figured out how to extract the drug." Sales of prescription opioid pain relievers have quadrupled since 1999, according to the Centers for Disease Control and Prevention, and overdose deaths have shot up, too.
If lawmakers really want to put a dent in the addiction problem, Publicker says, they should increase access to treatment.
Dr. Noah Nesin, chief medical officer at Penobscot Community Health Center in Bangor, says the current problem with opioid addiction has largely been driven by misguided prescribing practices. Making abuse-deterrent opioids more available, he says, could lead to more lax prescribing — exacerbating the addiction problem instead of easing it.
"Creating a dynamic in which we think, 'Oh, here's a safer alternative,' is an extremely relative comparison," Nesin says.
The FDA announced in April that it considers the development of opioids that deter abuse "a high public health priority," and says it is committed to supporting their development.
Nesin says he's wary of lawmakers dictating medical care. Rep. Barry Hobbins counters that increasing access to abuse-deterrent opioids may not be a silver bullet, but is one factor that could help prevent opiate addiction in the first place. His bill is expected to reach the floor of Maine's House of Representatives this week.
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