An October 2016 report by the Pew Charitable Trusts found that “children also are staying in foster care longer, and more children are entering the system because of a parent’s substance abuse.” Foster care systems are in crisis as well. “In Ohio, where more than 9,900 children are in foster care and nearly half of those taken into custody last year had a parent using drugs, case workers are having a hard time placing children with relatives. By the time the children get to foster care, they report, many of the adults in their extended family are addicted to opiates, too.”
There are no easy solutions to this crisis — so you’d think if there were medicines that helped prevent the scourge of opioid addiction it would be valued. But you’d be wrong. Many large insurers and pharmacy benefits managers are reluctant to pay for these new abuse-deterrent technologies.
Last week, this pattern of denial was endorsed by the Institute for Clinical and Economic Review. ICER is a private organization that recommends what drugs it feels should be covered and at what price based on the value of a new medicine. ICER and its funders — which include the largest health plans and PBMs — claim to use “transparent” methods to produce independent and objective recommendations.
The ICER report claims that abuse-deterrent opioids — designed to deprive users of a high when cooked or snorted — provide neither financial nor societal benefits, despite the fact they (ICER) were provided data demonstrating that over five years using abuse-deterrent Oxycontin prevented 4,300 cases of abuses, avoided 12,000 abuse years and saved $300 million in medical costs for $387 million in drug costs.
ICER confirmed those results, but tossed them aside.