AUGUSTA, Maine - Maine has one of the highest rates of opiate addiction in the nation. To reduce the problem, lawmakers are looking at ways to make opioids that deter abuse more affordable for patients seeking pain relief. Currently, insurance companies charge more for those drugs than they do for other types of pain medication. States like Maine are considering requiring insurance companies to cover them equally. But some physicians are skeptical that the strategy will work.
The problem of opiate addiction in Maine is one that Democratic Rep. Barry Hobbins knows about first-hand. "One of my family members has been struggling with this dreaded addiction of opiates for six years," he says.
So when pharmaceutical company Pfizer - which makes abuse-deterrent opioids - asked Hobbins to sponsor a bill that would require insurance companies to cover those drugs at the same level as regular opioids, he agreed.
Abuse-deterrent opioids are designed to be harder to crush, cut, or dissolve. Some form into a gel, so they're harder to inject. "The bill that I sponsored was, I think, one step to address the problem that we have," Hobbins says.
Massachusetts last year became the first in the nation to pass a similar law, which will take effect this October. This year, states from Vermont to California may follow suit.
The bill before Maine lawmakers initially sought to require insurance companies to cover all abuse-deterrent opioids as a preferred drug. It's been amended to allow insurance companies to choose whether or not to cover the more expensive abuse--deterrent opioids. If they do, it must be at the same co-pay as regular opioids.
"I would fall short of support, but it's certainly better than the original," says Katherine Pelletreau, executive director of the Maine Association of Health Plans, which represents four insurance carriers. She says there are only three prescription opioids approved as abuse-deterrent by the FDA, and they're all name brands. "We have concerns about requiring that a name brand drug, which can be significantly more expensive, be subject to the same cost-shares as a generic."
Abuse-deterrent opioids can cost hundreds of dollars more than opioids without those properties. While insurance companies aren't enthusiastic about the bill, neither are some doctors. Dr. Mark Publicker is the president of the Northern New England Society of Addiction Medicine. He says the bill has good intentions, but "I'm not sure it's going to have the desired impact."
Publicker says these opioids are not abuse-proof. An HIV outbreak in Indiana has been linked to the opioid drug Opana, "which is alleged to be tamper-resistant, and people with opiate addiction fairly quickly figured out how to extract the drug," Publicker says. Publicker says if lawmakers really want to put a dent in the addiction problem, they should increase access to treatment.
Dr. Noah Nesin, chief medical officer at Penobscot Community Health Center in Bangor, says the current opioid problem has largely been driven by misguided prescribing practices. Making abuse-deterrent opioids more available, he says, could exacerbate the problem, "creating a dynamic in which we think, 'Oh - here's a safer alternative,' is an extremely relative comparison."
Nesin is wary of lawmakers dictating medical care. Rep. Barry Hobbins says increasing access to abuse-deterrent opioids may not be a silver bullet, but it's one factor that could help prevent opiate addiction in the first place. His bill is expected to reach the House floor this week.
