Opioids easier to get than other pain meds for some disabled Medicare patients

May 24, 2018

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - For disabled patients on Medicare in Illinois, it's easier to get prescription opioids than other pain medications, according to new findings.

"Patients with disabilities requiring non-opioid pain medications appear to face increased barriers to medically necessary pain treatments," Dr. Allison Glinka Przybysz and two of her colleagues at Schwab Rehabilitation Hospital in Chicago write in a poster presented April 26 at the American Academy of Pain Medicine's annual meeting in Vancouver, Canada.

"We had been observing clinically that patients with disabilities seemed to have great difficulty obtaining medications for painful spasms and neuropathic pain and less difficulty obtaining opioids," Dr. Przybysz told Reuters Health by email, "so we set out to see whether our observations were appropriately rooted in the available data."

The researchers reviewed the 2017 Centers for Medicare & Medicaid Services (CMS) Medicare Part D Illinois registry data for first-line drugs to treat pain in patients with spinal cord injuries, post-stroke pain, phantom pain and neuropathies. The authors examined tier levels, associated costs per patient, prior authorization requirements and quantity limits.

In Illinois, around 24% of patients with disabilities were Medicare recipients. Across all drug plans, quantities were limited 47% of the time for gabapentin and 76% of the time for pregabalin.

Compared with opioid pain medications, tricyclic antidepressants were 2.5 times (P>0.05) and transdermal lidocaine 33 times (P

The tier level of lidocaine products was significantly higher than the tier level for opioids, with 57.1% of plans placing lidocaine products in the highest level.

Dr. Ray Lee, who also worked on the study, said he and his colleagues deal with this issue almost daily.

"Instead of prescribing proper medications for neuropathic pain," he told Reuters Health by email, "treatment delay leads to uncontrolled pain and ER visits, which increase healthcare costs, and/or to prescriptions for opiates, which are a 'quick' fix with very little to no prior authorization blockades."

"The patient returns to his or her primary care physician, who may hesitate to prescribe an opiate and goes through the red tape needed to complete prior authorization for the patient's proper medication (which even then is limited in quantity)," Dr. Lee added. "This process further delays treatment and runs the risk of the patient developing opiate misuse and abuse disorder."

Dr. Jonathan Song, the third author on the poster, explained in an email to Reuters Health that many of their patients endure harsh socioeconomic realities.

"In our rehabilitation hospital, we treat patients in an underserved area who suffer life-changing injuries, such as spinal cord injuries and traumatic brain injuries, which not only affect their physical state but can also cause significant cognitive deficits and psychological trauma," he said.

"On top of these," he added, "they must face obstacles to obtaining appropriate medication in the form of prior authorizations and medication costs."

Dr. Przybysz said that identifying these barriers is only the first step: "We must confirm where and the extent to which the problem exists so future patients can be treated appropriately. Additionally, we should address the disconnect between our treatment algorithms and the medications that are available to us to prescribe without restriction."

The authors plan to analyze national Medicare data so see if their results are consistent across all states.

The study had no commercial funding, and the researchers report no conflicts of interest.

SOURCE: https://bit.ly/2kpPD9b

American Academy of Pain Medicine 34th Annual Meeting 2018.

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