Medicare Coverage for Misuse-Deterrent Painkillers Falls
Medicare coverage for misuse-resistant painkillers is declining in favor of coverage for generic medications that do not have misuse-deterrent properties, according to a recent Avalere Health study, Kaiser Health News reports.
The study found Medicare coverage for long-acting prescription painkillers was included in about 46% of plans in 2012 and 36% of plans in 2015. Further, the study found that Medicare coverage of OxyContin, a brand-name painkiller available in a misuse-deterrent form, declined more significantly than coverage for other long-acting opioids that are not misuse-resistant over the past three years. According to the study, OxyContin was covered in about 33% of Medicare Part D plans in 2015, compared with 61% of such plans in 2012.
Meanwhile, the study found a generic drug containing the same active ingredient as OxyContin, called oxycodone, but which lacks OxyContin's misuse-deterrent qualities, was covered by almost 100% of Medicare Part D plans from 2012 to 2015.
Caroline Pearson, a senior vice president at Avalere and the study's co-author, said the findings "suggest that the Part D plans are not considering abuse deterrents as any meaningful part of the coverage decisions."
According to KHN, price could be one reason driving the coverage decisions. OxyContin typically costs about $632 for a 120-day supply of the drug, while generic versions similar to the drug usually cost around $28 for the same supply, according to price tracker Healthcare Bluebook. Pearson said while the introduction of more misuse-resistant painkillers to the market could help to lower prices for such medications, "they're never going to be the same price as a generic." She added, "At some point, payers or policymakers need to decide whether they're willing to pay a premium to avoid abuse" (Andrews, Kaiser Health News, 6/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.