New Blue Cross Rules Limit Access to Painkillers

New Blue Cross Rules Limit Access to Painkillers

The largest health insurer in Massachusetts is adopting a new program that could significantly limit the amount of pain medication patients receive. The policy, unveiled this week by Blue Cross Blue Shield of Massachusetts, is one of the strictest taken by a private insurer and is the latest in a series of efforts around the country to combat the prescription drug abuse epidemic by limiting access to powerful opioids.

Starting July 1, Blue Cross will allow patients to fill a 15-day prescription and one 15-day refill for short-acting painkillers, such as Percocet and Vicodin. Any further refills after 30 days will trigger a Blue Cross review, requiring physicians to certify that their patients have been counseled about the risk of addiction, as well as an agreement that all subsequent prescriptions will be written by the same doctor and filled at the same pharmacy. The latter rule is aimed at ending “doctor shopping” – in which patients go from doctor to doctor to get a prescription.

“A vast majority of our members who are prescribed pain medications use them safely and appropriately,” said Dr. John Fallon, senior vice president and chief physician executive for Blue Cross. “Still, we must also acknowledge the serious public health problem that the misuse and abuse of prescription narcotics pose to our communities, and we have a responsibility to put in place reasonable safeguards that help to prevent those problems from occurring.”

Blue Cross adopted the new policy after a review showed that 30,000 of its 2.8 million members had received prescriptions for short-acting painkillers for more than 30 days. The insurer believes that practice increases the chances of misuse, addiction and diversion – with unused pills being used by family members or being sold on the street.

The health plan will also have new guidelines for long-acting pain killers, such as fentanyl and OxyContin. Less than 3,000 of its members receive long-acting opioids. Under the new rules, those drugs could not be prescribed at all without prior authorization from Blue Cross.

Cancer patients and those with terminal illnesses will be exempt from the rules. It’s not clear how the rules will impact patients with long-term chronic pain, who do not have cancer or a terminal disease. About 100 million Americans suffer from chronic pain, according to the Institute of Medicine.

Mark Collen, an advocate for chronic pain patients, believes the Blue Cross policy will create more rules and paperwork for doctors, which could raise the cost of health care and limit access to opioids for people with chronic pain.

“This may be guesswork that may increase insurance costs when their members end up in the emergency room trying to get their pain treated,” Collen told American News Report. “It may also increase costs when their members need to see their pain doctor on a monthly basis as opposed to every two or three months.  In addition, increased rules may decrease the number of doctors willing to prescribe opioids — again sending more people to the ER for pain treatment.”

Collen says there is no evidence that “pain contracts” between doctors, patients and insurers have any impact on drug abuse. He said the other rules limiting prescriptions to one pharmacy and one doctor were reasonable.

Prescription drug abuse is the fastest growing drug problem in the United States. In 2010, the Centers for Disease Control and Prevention reported that 2 million people admitted using a prescription painkiller to get high. Seventy percent of the painkillers were obtained from friends or relatives; either for free, through purchase or by theft.

According to the Massachusetts Department of Public Health, the number of prescriptions for “Schedule II” narcotic pain killers has doubled in the past decade alone, leading the agency to warn  that “although it is important to properly treat pain, the availability of these prescription drugs in the community can be a risk.” Schedule II drugs include fentanyl, methadone, oxycodone, OxyContin, and Percocet.

Authored by: Pat Anson, Editor

There are 8 comments for this article
  1. Johnny at 5:17 pm

    It is a shame that there are so many people out there that are taking the pain medicines for all the wrong reasons. I do agree, how ever I have a hard time buying that BCBS’s main concern in anyway is combating country wide abuse. I think as in any business the main concern is the bottom line. Reducing the number of questionable prescriptions filled that the co-pays surely fall short of covering the cost of the medicine. To allow the insurance company to act in a policeing action in any form is insanity. I do agree that Doctors with patients that do require ongoing treatment with pain medication should have no problem with supplying documentation proveing the legitimency of the treatment. I can not agree with changeing in any form of what a Doctor prescribes or the amount of days the medicines cover the patient for as long as the Doctors documentation supports the treatment. BCBS (or appropriate agencys) focus I believe should be on approaching Doctors for documentation supporting ongoing treatment. This would keep legitimate patients out of harms way and make more sense instead of perecuteing everyone. Ligitiment patients already suffer enough and now your going to make it harder then it is already is on them shame on you. I know people who have problems that keep them in pain on a daily basis and just the change of the weather is incredibly painfull to them not to mention the pain their always in from past injures. I have a friend that survived at least two auto accidents that most people have not lived through. while stopped at a red light he was hit 65 mph. head on that left him with a very painfull life only to be hit once again about 7 years later 75 mph. from behind while he was stopped in traffic. After all that he had a little problem with his balance at times and it just so happens he fell in his own driveway that shattered his femur bone. Now he lives in pain everyday and yes he is on pain medicines I do not think that it is fair at all that somebody like this has to be subjected to going through the unfair changes that BCBS is making legitiment pain medication patients go through. Yes there is a problem with the system but there is a better way to fix it! Please do the right thing!

  2. Nancy at 5:39 pm

    This new policy directly affects me. BCBS of MA is my insurer, and I am a legit chronic pain sufferer. Needless to say, I am terrified for my future. Someone at an insurance company (that I PAY for), gets to decide whether or not I deserve to have my pain treated?

    I suffer from a genetic, connective tissue disorder, called Ehlers-danlos syndrome. It causes the production of faulty collagen, which proves strength and elasticity to joints, organs, etc.. There is no cure for EDS, and treatment is based on symptom management….the WORST of which is severe acute and chronic pain. I have Hypernobile, loose, unstable joints that easily dislocate, and subluxate. I have dislocations of both shoulders, my pubic symphysis (pelvis), knee caps, jaw, foot bones, sacroiliac joints, hips, and wrist. My most recent TORTURE is sudden, electric shock, jolting, stabbing cervical spine dislocations that compress my spinal cord, and bring me to my knees in agony. I have had multiple joint surgeries, including open Bankart procedures with 3 metal anchors in each shoulder. Oh, and these are just ways that EDS effects my JOINTS. I have spent most of my life MISdiagnosed and MIStreated for other conditions that I DO NOT have! I was finally diagnosed about two years ago, at age 40, by a wonderful geneticist in Boston. In the past, I have tried MANY non-opioid treatments for pain. These include PT, acupuncture, message, chiropractic, NSAIDS & numerous other OTC and prescribed medications, cortisone injections, facet joint blocks, SI belts, braces, splints, topical analgesics, heat / ice, etc…. Nothing has ever given me any lasting or meaningful relief from pain. I have been in a state of complete hopelessness and despair from untreated, unrelenting, severe, chronic and acute pain. Thankfully, I have found significant pain relief in long-term opioid therapy. I use one prescriber (the doctor who saved my life!), one Pharmacy, and take and store my medication safely and responsibly. Opioid medication is the only pain treatment that has reduced my pain. I still use many of the above treatments as adjunct therapies to my medication, but without opioid medication, I live in a state of severe, debilitating pain. I still have pain, as nothing will ever give me 100% pain relief, but my medication has allowed me to SLEEP, eat, function, and engage in life. I am going to ASSUME that BCBS of MA, will not deny me access to the only pain treatment that has ever worked for me. I am going to assume, that Dr. John Fallon, who is the Chief Physician Executive at BCBS of MA., wouldn’t let that happen. I have read that this new policy, effective July 1, 2012, will not apply to end-of-life patients, or those who have cancer. Needless to say, I was VERY glad to read that. My beloved aunt passed away a few years ago, before my EDS diagnosis. She was in severe pain at the end of her life. She said to me, “Oh, don’t worry about ME, my pain will end soon, dear. It’s YOU I worry about. I worry that you will have to spend the next 40 years in terrible pain”. Thankfully, HER pain ended. Mine? Well…..we will just have to see if BCBS approves me, or not.

  3. Danny at 5:33 pm

    What is truly sad to me is that a good amount of pain and suffering could be avoided if medical science could get to the real root of the problem.

    Last year Blue Cross had been billed a couple of hundred thousand for Median Branch Blocks, Neural Ablations, SI Jo9nt Injections. I have no idea how much has been spent in Vicodan, Fentanyl, and Tramadol and yet the pain could not be stopped or seen on any of the tests.

    I found a procedure that my insurance would not cover that Sports Medicine Doctors perform and immediately my pains started to decrease. Since I have spent about 8,000.00 out of my own pocket I have saved the insurance company 10 to 20 times that in procedures and my opiate use is steadily decreasing.

    The sad thing is that even though this is used by the big sports franchises to protect their investment the insurance companies will not push for more studies to see if this would be a good alternative for the other procedures that do nothing for a great amount of the population except to raise the cost of insurance each year.

  4. Reston at 8:37 am

    After a brief decade or so of relative pain management enlightenment in the U.S., the pendulum appears to be on a return swing toward a hellish life for chronic pain sufferers; goodbye quality of life, hello interminable suffering.

  5. Pat Anson at 1:50 pm

    Ann, the new rules go into effect July 1.

  6. Ann Bodio at 1:06 pm

    Someone forgot to notify the patients……..According to your rep this has gone into effect immediatly and there are no exceptions. I am unable to have a perscription placed last week filled.
    So for the honest person who plays by the rules, see’s one doctor we are now all labeled addicts that must be controlled.
    Is this how your going to “win” your war on drugs?? Can’t get the dealers so lets go after the doctors & patients.
    Maybe you will next decide who should live and who should die……………patients in pain and agony are not the ones who should be further victomized.

  7. Serena Johnson at 1:11 pm

    And so, just as Collen states, the vast majority of legitimate patients with chronic pain will be punished – for the communal good? How does this make sense?

    Oh wait – maybe that has to do with the fact that the Obama administration has turned control of schedule II meds over to the FDA and the DEA. Always good to have law enforcement running healthcare, right? And the FDA, which is part of the Department of Health and Human Services, same as the CDC. Because after all, we are just statistics, aren’t we?

    And that’s ok, right? Never mind the patients who may not be able to drive to the extra appointments or pharmacy trips. Or those who will die – because there is just as strong a correlation between suicides and unmanaged or under-treated pain. Or, those who simply give up because the unnecessary trip to the ER finds them treated and junkies instead of patients. After all – we all know those are the only people who show up asking for strong pain medications, right? Or – those who will become desperate and suffer harm or death from overuse of NSAIDS and other medications which are just as dangerous when abused.

    This reminds me of the Marianna Boat Lift. Remember? When Castro dumped his undesirables on the U.S. Because if he has his way in this, he’ll simply drive the sick to other countries where healthcare is still healthcare, and not law enforcement.