Insurance Won’t Cover Alternatives to Opioids

August 12, 2016

Over the past decade, the US has undergone an opioid epidemic.

Prescriptions for opioid painkillers like oxycodone, hydrocodone, fentanyl, and morphine have skyrocketed — and, with them, the number of overdoses related to opioids.

The trend has been decades in the making.

Increases in painkiller prescriptions are linked to a “big push” in the early 1990s from medical groups encouraging doctors to treat pain more aggressively, according to Dr. Ted Cicero, a professor of psychiatry at Washington University in St. Louis and an opiate-use researcher.

Though the increased focus on pain treatment resulted in increases in opioid prescriptions in most doctors initially, for years now, pain specialists have advocated using alternative treatments to alleviate their patients’ chronic pain.

There’s one problem: Health-insurance companies are increasingly cutting reimbursements for these alternative treatments or not covering them at all.

Steroid injections, joint injections, fluid injections, physical therapy, nerve blocks, and radio-frequency ablation are just a few of the treatments advocated by pain specialists in place of opioids. Such treatments are frequently called interventional pain treatments.

“Every year, pain interventions go to the chopping block, and doctors have to figure out how to provide that treatment and make ends meet,” Dr. Janet Pearl, the medical director of Massachusetts-based pain-management center Complete Pain Care and the secretary of the Massachusetts Society of Interventional Pain Physicians, told Business Insider.

A difficult choice for patients and doctors

The policies of insurance companies have forced doctors to increasingly offer pain patients a difficult choice, according to Dr. Shalini Shah, the director of pediatric-pain management at UC Irvine Health.

Pay for expensive alternative treatments out-of-pocket, use opioids and possibly suffer a myriad of side effects and risk opioid addiction, or choose to do nothing and live with debilitating pain.

“Even if we want to climb a population out of the well of the opioid epidemic and give alternatives, we can’t,” Shah told Business Insider. “Patients can’t afford the alternatives and insurance companies won’t cover them.”

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