A proposed Florida bill that would provide coverage for brand-name versions of prescription painkillers under health insurance policies has sparked concerns the measure could raise the cost of prescription drugs and fail to curb opioid abuse in the state.
Introduced by State Sen. Lizbeth Benaquisto (R-30), the bill, titled Health Insurance Coverage for Opioids, would allow health insurance policies that already cover opioid analgesic drug products to pre-authorize brand-name versions of the medications.
“It’s not clear to me what exactly the state senator was trying to accomplish, especially considering Florida’s history of having a proliferation of pill mills and then closing down pill mills and putting them out of business,” Devon Herrick, senior fellow at the National Center for Policy Analysis, told Florida Business Daily. “The bill apparently would allow preauthorization of name-brand; it wasn’t clear if it would also allow preauthorization of generics or why there would be a distinction.”
Herrick, who wrote an article on the abuse of prescription drugs under Medicare drug plans, said much of his work involved finding a solution to “doctor shopping” that allowed pill mills to thrive.
“I looked at the Medicaid program because they are already doing it. Medicaid has long had a 'lock in' where if you are found to be using a large variety of narcotics — which is typically not good — they lock you down to one doctor, one ER, one pharmacy, so they can control it,” Herrick said.
Since the Centers for Medicare & Medicaid Services (CMS) gets the Medicaid prescription bill, the health care system can easily see who is getting multiple prescriptions filled at multiple pharmacies, Herrick said.
Another problem Herrick sees with the bill is the likelihood that it would actually increase the cost of medication because consumers would have to pay a higher price for brand recognition and patent protection associated with name brand prescriptions.
“In preauthorization, I can see the utilization of narcotics and I can definitely see it increasing the utilization of high-price, name-brand narcotics," he said. "And right now, of course it (has) been in the news lately, the rise in cost of drugs."
Herrick said there are instances when brand-name prescriptions are necessary for patients who may not tolerate a generic version of a medication well, but that discussion should take place between doctor and patient.
“Individuals can talk to their doctor and have their doctor prescribe brand and then ask for it to not be substituted if they find they can’t take the generic," Herrick said. "Most states already have provisions in law, but in some states it does require preauthorization because the insurance company is not particularly keen on paying $150 for a prescription that would otherwise cost $20."
If approved, Senate Bill 422 would take effect Jan. 1, 2017.