Milton Packer wonders
if people suffer and die because it is cost effective
On 2017/09/17 , The New York Times and ProPublica collaborated on an interesting story . You may have missed it .
As everyone knows , we are in the midst of a horrific opioid addiction epidemic . Physicians are prescribing opiates for pain relief , and patients are becoming addicted to them . One-fifth of patients who receive an initial 10-day prescription for opioids will still be using opiates a year later . That is simply extraordinary .
Physicians are prescribing opiate formulations that are highly addictive . But they do not need to do that .
There are several newer formulations that relieve pain and are far less addictive than older agents . But they are prescribed uncommonly . Why is that ?
It is not because physicians are uninformed .
It is because payers will not pay for the alternatives . The less-addictive opiates are more expensive , so payers have declined to support them . Patients get addicted because paying for highly addictive opiates saves the payers money .
The New York Times also noted that the treatment of opiate addiction is expensive . It is far cheaper for payers if physicians continue to prescribe opiates than if physicians enrolled a person into a drug addiction program .
What does that look like ? Patients get more prescriptions for opiates instead of getting the help they need .
The Payers Are in Charge
If you are looking for someone to blame for the opioid epidemic , you can certainly blame physicians . You can blame pharmaceutical companies . But while you are at it , don’t forget to include payers .
This conclusion should not be surprising . We live in a world where payers — not physicians — determine what drugs and treatments patients receive .
If patients have a life-threatening condition , it is not unusual for a payer to demand that a physician first prescribe a cheaper and less effective alternative . Physicians know that the drugs they are allowed to use may not work very well , but frequently , payers demand that they be tried first anyway .
What happens if the patient doesn’t respond to the cheap drug ?
Often , the physician continues to prescribe it , because — to gain access to the more effective drug — physicians need to go through a painful process of preauthorization . For many practitioners , it isn’t worth it .
Don’t patients eventually get the drugs that they need ?
No . All too often , physicians stop trying . Or patients get frustrated and give up . Often , payers says No ! No matter how many times they are asked . And if the drug is for a life-threatening illness and enough time passes by , then the patient may no longer be alive to demand that they get the right drug .
So we spend more for healthcare than any other country in the world , but Americans do not get the care they need . There is a simple reason . Treatment decisions are not being driven based on a physician’s knowledge or judgment . They are being driven by what payers are willing to pay for .
How many people are affected by all of this ?
Everyone .
That includes me and my family . That includes everyone that I know .
Medicine has made incredible progress in the last 20-30 years . But you are not likely to benefit from it .
Do you want to blame the high cost of drugs ? You can do that , but if you do , you will be missing the point . We should expect better drugs to be more expensive than less effective ones . But we do not expect to have a company decide that we will get the inferior drug simply because they want to make a profit .
Are payers the leading cause of death in the United States ? If you think this is a crazy question , please think again .
Milton Packer MD 2017/11/01
http://www.medpagetoday.com/blogs/revolutionandrevelation/68935
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