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Opioid epidemic boosts costs for health insurers

In a four-year period, health insurers’ spending on patients addicted to opioid painkillers has increased more than 1,000 percent, revealing the impact of the opioid crisis on the health care system.

Between payments to hospitals, laboratories, treatment centers and other medical providers for opioid-dependent patients – or patients addicted to prescription medication or heroin – health insurers in the U.S. spent $446 million in 2015.

In 2011, health insurer payments for opioid-dependent patients totaled $32 million, according to a white paper released by Fair Health Inc., a New York-based nonprofit that provides cost data to the health care industry and consumers.

Fair Health’s white paper found that on average, health insurers paid $19,333 on patients with opioid dependency in 2015, compared to $3,435 on patients without a substance use disorder.

The growing cost of patients addicted to opioids comes as no surprise, with the U.S. facing what some are calling the worst health care epidemic in history.

Nationwide, the opioid epidemic has claimed 165,000 American lives between 2000 and 2014, according to the National Security Council.

As of 2015, an average of 10 people a day are dying in Pennsylvania alone from drug overdoses, a coroners report said.

Highmark’s approach

Local insurers are investing in the opioid crisis by finding ways to help reduce overuse of pain medication. People who become addicted to opioid pain pills are more likely to become addicted to heroin.

Poor pain management and the misuse of opioid pain pills are among the root causes of opioid and heroin addiction, according to recent studies.

Pittsburgh-based Highmark Inc. is not looking at the opioid epidemic as much from a cost perspective at the moment, but it is taking a number of steps to address the public health crisis, according to spokesperson Leilyn Perri.

Highmark has partnered with Tennessee-based Axial Healthcare, a company founded by health care professionals to address the rise in health care costs associated with pain management and opioid use. Under the partnership, Highmark is tracking physicians in certain markets so that the insurer can grade them on their prescription-writing habits.

Highmark will be able to identify doctors who may be at risk of overprescribing opioids and then assist them. If a physician doesn’t comply with Highmark’s standards, the company could take additional actions.

This program is already running in West Virginia, and Highmark will start it in Pennsylvania next year, Perri said.

Reducing the amount of patients at risk of becoming dependent on opioids could lower health care costs in the long run.

Lenay Ruhl

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