NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC., SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS, MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., M.B.A., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA, AISHA GARDNER, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
1. What is the central concern addressed in the letter from the State Attorneys General to America’s Health Insurance Plans (AHIP)?
The central concern is the devastating opioid epidemic, which the State Attorneys General identify as the “preeminent public health crisis of our time.” They urge AHIP to take proactive steps to encourage its members (health insurance companies) to revise their payment and coverage policies. The goal is to prioritize non-opioid pain management options over opioid prescriptions for treating chronic, non-cancer pain, thereby combating the over-prescription of opioids that significantly contributes to the crisis.
2. What are the key statistics highlighting the severity of the opioid epidemic according to the State Attorneys General?
The letter outlines several stark statistics:
- As many as 2 million Americans are currently addicted to or dependent upon prescription opioids.
- In 2014, 10 million people reported using opioids for non-medical reasons.
- The epidemic costs the U.S. economy an estimated $78.5 billion annually, with state and local governments spending nearly $8 billion each year on criminal justice costs related to opioid abuse.
- Opioid overdoses kill 91 Americans every day, with more than half of these deaths involving prescription opioids.
- Prescriptions for opioid painkillers have nearly quadrupled since 1999, despite no commensurate increase in reported pain levels, contributing to a rise in overdose deaths.
3. Why do the Attorneys General believe that reducing opioid prescriptions will not leave patients without effective pain management options?
The Attorneys General argue that while opioids are appropriate in some situations, they are often prescribed when evidence suggests they are ineffective or even dangerous for chronic, non-cancer pain. They cite the American Academy of Neurology, which states that opioids provide “significant short-term pain relief” but lack “substantial evidence for maintenance of pain relief or improved function over long periods of time.” They advocate for a range of effective non-opioid alternatives, including non-opioid medications (like NSAIDs), physical therapy, acupuncture, massage, and chiropractic care, which doctors should be encouraged to explore.
4. What role do insurance companies play in perpetuating or solving the opioid crisis, according to the letter?
Insurance companies play a critical role because providers often favor treatment options that are most likely to be compensated. The current “status quo” may include financial incentives that favor opioid prescriptions. By adopting an incentive structure that rewards the use of non-opioid pain management techniques, insurance companies can significantly reduce opioid prescriptions, promote evidence-based and more effective therapies for chronic pain, and ultimately contribute to cost-efficient solutions. They are in a position to positively impact the treatment of chronic pain.
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