Cummings Investigates Reports That Plans, PBMs Favor Addictive Opioids Over Expensive, Less-Addictive Drugs

Published by Inside Health Policy

House Oversight and Government Reform Committee ranking Democrat Elijah Cummings (MD) on Thursday (Oct. 19) began investigating reports that health plans and pharmacy benefit managers make it difficult for people to get less-addictive pain killers while making it easier for them to get cheaper, highly-addictive drugs.

According to a September investigation from the New York Times and Pro Publica, most prescription drug plans offered under the Medicare Part D prescription drug benefit cover common prescription opioids without limitation. Conversely, only one-third of these plan member had similar access to less addictive, but more expensive, opioids. The report also found that when plans do cover less addictive or no-addictive opioids, they often require patients to take extra steps, such as obtaining prior approval from insurance companies, and they place less-addictive drugs on higher cost-sharing tiers.

“This is not a hypothetical problem. The over-prescription of opioids leads to addiction and death,” Cummings wrote. He added, “Insurers and PBMs have developed initiatives to address the opioid epidemic, but this new report indicates that fundamental financial incentives may be driving insurers and PBMs to steer beneficiaries to the very drugs that are fueling the opioid crisis.”

Cummings requested that several companies provide lists of brand-name and generic medications for their plans, the cost-sharing tiers on which the medications are placed, and the classification of the drugs as non-narcotics or narcotic/opioids. Cummings requested the documents of UnitedHealth Group, Optum, Humana, CVS Health, Aetna, Anthem and Express Scripts, and asked them to respond by Nov. 2.

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