Responding to the Opioid Crisis: Insurers Balance Stepped up Monitoring, Restrictions with Need for Appropriate Pain Treatment

By Dania Palanker, Sandy Ahn and Sabrina Corlette

The United States has an opioid epidemic, with an unprecedented number of opioid-related deaths in recent years. The rise in opioid addiction and overdose is further complicated by the need to effectively treat the approximately 100 million people living with chronic pain. As more people have health insurance than ever before, commercial health insurers are at the front line as payers of opioid prescriptions and other treatments for pain.

In order to explore how insurers are responding to the opioid crisis while also meeting the needs of members living with chronic pain, we recently conducted a literature review and interviewed insurers, providers, and patient advocates. We discuss our findings in a new report funded by the Robert Wood Johnson Foundation.

  • Provider and patient advocates asserted that health insurers have fueled the opioid epidemic by incentivizing physicians and patients to use opioids for pain because of coverage gaps for non-opioid pain treatment. Respondents noted that limits on services such as physical therapy, difficulties accessing mental health services, and medical management techniques create incentives for providers to rely heavily on opioids to treat patients living with chronic pain.
  • Insurers described various approaches they are taking to curb opioid prescriptions. All insurer respondents reported that they track opioid prescriptions and limit the quantity or dosage of opioid prescriptions to reduce overprescribing and unused opioid medications.
  • Three of the five insurers interviewed are working to improve pain care through the use of non-opioid pain treatment modalities by educating providers and patients, providing tools to primary care providers to improve treatment of pain, and encouraging patients to use other, non-opioid treatment options. However, these insurers are generally not closing coverage gaps identified by providers and only one of the five insurers has a comprehensive approach to expanding access to pain care.
  • Insurer respondents are striving to reduce opioid prescriptions while expanding the use of non-opioid pain treatment, but they face challenges. The lack of pain specialists and integrated pain management clinics, a need for more provider education, and patient expectations inhibit insurers’ ability to accomplish this goal.

People with pain are caught in what some have called “a civil war in the pain community” as people disagree on the balance between the need to treat chronic pain and the need to prevent opioid misuse. There are concerns that people with chronic pain are losing access to treatment options because of efforts to prevent opioid misuse by changing prescribing practices. At the same time, people living with chronic pain do not always have adequate access to non-opioid based therapies through their insurance.

You can read the full issue brief here.



  • Shirley Hinton says:

    Good article finally ..some truth in it .. both sides Been to the beat pain doctor and on other side …the biggest coward so called doctor ..whipo i told where to stuff it ..and have chosen to suffer till i find a doctor that is what they are suppose to be .. my advocate .because of his greed and now the compnay he works for sold out his first ward .. me . COWARD NOT DOCTOR !
    Just what the world needs another coward with a degree .

  • This article is regrettably based more on hype than facts. Reality is VASTLY different than portrayed here. While it is true that insurance disincentives are a factor in the non-availability of non-opioid therapies, chronic pain patients generally are prescribed opioids only after the failure of multiple alternative protocols. Moreover, since 2011, the rate of opiod prescription in chronic pain has dropped by a third, while the number of deaths in which some form of opioid is believed to be a factor has more than doubled.

    As noted in CDC data, overdose deaths are presently dominated not by opioids given under prescription, but by street drugs: heroin, imported fentanyl, diverted or stolen morphine and methadone. In States like Massachusetts and Alabama where death statistics have been analyzed and cross-matched against State prescription databases, it has been found that about 25% have a current prescription. Moreover, in about half of the deaths attributed to opioids of all types, about half of the patients have also been prescribed a benzodiazepine. In a majority of cases, alcohol is also a factor.

    It is credibly arguable that the current “opioid epidemic” is partly a result not of over-prescription of drugs, but rather of under-treatment of pain with patients being forced into the streets by sheer agony. Thousands of pain patients have been unilaterally dropped from pain management practices and doctors are leaving the field in droves. It is time to stop the government’s war against chronic pain patients. And it is time for insurance companies to wake up and smell the coffee: this campaign is increasing costs across the board in disability and losses to the job market. And you folks have become accessories to the crime.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.