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  • AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment

    Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain. But that encouragement won't have much impact unless it's accompanied by payment coverage policies that make the nonopioid approaches more feasible to pursue, they write.

    In a letter to America's Health Insurance Plans (AHIP), the health insurance industry's trade association, AGs affiliated with the National Association of Attorneys General describe the opioid crisis as "the preeminent public health crisis of our time." The AGs say that while addressing addiction and recovery are crucial components in solving the problem, the issue must also be addressed further upstream—namely in the ways opioids are overused as a treatment for pain.

    "The unnecessary over-prescription of opioid painkillers is a significant factor contributing to [the opioid epidemic]," write the AGs. "When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications…to physical therapy, acupuncture, massage, and chiropractic care."

    The AGs write that the needed encouragement must come through insurance company incentives to follow a nonopioid treatment path. "Simply asking providers to consider providing alternative treatments is impractical in the absence of a supporting incentive structure," they write. "All else being equal, providers will often favor those treatment options that are most likely to be compensated."

    Besides helping to reduce the prevalence of opioids, nonopioid pain treatment is consistent with the science around pain management, according to the AGs. "Incentivizing opioid alternatives promotes evidence-based techniques that are more effective at mitigating this type of pain, and, over the long run, more cost efficient," they write. "Thus, adopting such policies benefits patients, society, and insurers alike."

    In a September 22 response, AHIP stated that its members "continue to expand and refine a comprehensive, multi-faceted approach to preventing and managing opioid misuse and related conditions," including "identifying alternative forms of pain management." The AHIP letter lists several member initiatives, including a push by Anthem to encourage providers to follow opioid prescription guidelines from the US Centers for Disease Control and Prevention. AHIP also states that it's working with some members on "exploring and improving access to non-pharmacologic pain treatments that have been proven effective in reducing pain."

    The AHIP letter also asserts that medical management—prior authorization, prescription tiering, plans that require "an evidence-based systematic approach to therapy," and the like—is 1 of the "most effective tools health plans have" in the battle against opioids, and has been mischaracterized as a "barrier" to treatment.

    "To effectively solve the opioid crisis, it must be addressed comprehensively by all stakeholders—from law enforcement and the justice system, to social services agencies and state Medicaid programs, to health care providers, pharmacists, health plans, and pharmaceutical companies," AHIP writes. "Only through collaboration and cooperation can we address—and solve—this crisis, and further improve efforts for prevention, education, intervention, and treatment."

    APTA's award-winning #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, #ChoosePT includes a video public service announcement, as well as other targeted advertising and media outreach. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

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    • I have Been on Opiates for years now and just recently had an overdoes do to chronic low back and leg pain. As of right now i am trying to get a spinal cord stimulater so that i can stop taking the Hydro's but the fight with the insurance company is making it hard to have a good outlook on things. all i have asked for the last 6 years is to not be in pain and after a failed back surgery with nerve damage that goes all the way down my left leg makes it hard to take care of my 4 children. my insurance company is denying me this Trial to get off the opiates. i think it is sick that there are people working for these company's looking for key words that will deny the procedure.i asked the name of the "Dr." that is employed by the insurance company looking at my case and all i got was the name when i asked what this "dr.'s" credentials are i got no answer. how can someone that does not even specialize in that field make a decision about what is good for the individual.

      Posted by Emily McGinley on 6/7/2018 2:40 PM

    • Having ANY kind of pain transforms a person into a zombie overnight. It is a complete disgrace that highly-paid insurance companies completely disregard requests for financial coverage in cases of back pain!!! Oh sure, they'll give me meds, and even allow me PT, but I need Massage Therapy to help everything else along. The system is not only SICK, it's been DEAD for a long, long time, and until insurance corruption is exposed for what it really is, innocent people will continue to suffer, with no other recourse than to turn to drugs.

      Posted by Linda Williams on 9/22/2018 1:58 PM

    • Did you know that thug drug dealers ACTUALLY deliver their drugs like illicit Fentanyl to your door like a Dominos Pizza? I did not know that until April 29th, 2017 in the dark damp hours of a rainy spring pre dawn hour. My younger brother died just last year in April 2017 of a Heroin/Fentanyl Overdose. I ❤️ my brother immensely, always have, always will. The sheer pain of his death alone saddens me. What makes matters much worse is knowing that the sins of my own brother (and many JUST like him) would inadvertently affect my chronic pain control just a year after. It’s like double the pain — and it honestly plays tricks with my head. I understand the opiate epidemic — but honestly, my brother didn’t actually die of a Heroin overdose. You know what he died of? He died of an illicit Fentanyl Overdose. That is the TRUE epidemic going on! Let me tell you, the medical examiner was absolutely dumbfounded and shocked at his toxicology report. The amount of illicit Fentanyl in his system was one of the highest he has seen. More than 4 shots of Narcan couldn’t touch the amount of illicit Fentanyl that was in my brothers system/blood stream. Seeing him lying there dead on the basement floor is a sight I can not unsee. I wished I had not looked because that was NOT how I wanted to remember my brother. My brother had an ADDICTION! It was an addiction of his own choosing and why are chronic pain sufferers being pushed aside like pond scum to help the “masses” of folks that choose to die from this illicit drug? So to my point ... On the other hand, chronic pain sufferers have a physical /chemical DEPENDENCE on the opiate — big, big, HUGE difference. But the mass media has been taught otherwise. The pharmacist, the news outlets, many in the general public, physicians, the government in general, ect. do NOT know the difference between the two. And they want to lump BOTH the chronic pain sufferers in the SAME bag as folks just like my brother who, unfortunately brought an addiction upon themselves (not purposely) but nonetheless, his disease brought about his own demise. Last but certainly not least, the Mexican drug cartels and the drug smuggling in from countries like Canada and Mexico are to blame for the illicit Fentanyl abuse, and more importantly deaths/overdoses. Why? Illicit Fentanyl is coming from a much more potent drug — an elephant tranquilizer called Carfentanil. This drug has its appropriate uses — but when you put a drug meant for an 8,375 pound animal in a human being with let’s say an average size of 137 pounds, it is an ABSOLUTE recipe for disaster! I mean, come on, even the first responders don’t want to touch this stuff. Even the smallest amount of powder wiped on a hand can absorb into a persons body and cause an overdose. Carfentanil is an analog of the synthetic opioid analgesic fentanyl. A unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine. So go inject some of this stuff, only it is sliced, diced, and laced with a little other “Great Stuff” for your body like baby powder, a little bit of Heroin to boot, even some Valium. There you go! They wanna make this stuff good so you get hooked and come back for more and more, thus sending more abusers there way, and become a customer for life (or whatever amount of life the drug dealer can get out of you)! Then when you die, they just move on to the next Tom, Dick, Harry, or Mary! This illicit use of Fentanyl, cut from Carfentanil, is honestly, in my humble opinion, the worst conspiracy hidden by the government for some time. Why? I think because they know they are losing the overall war on drugs. If you think about it, if you were in charge of drug control into the country, wouldn’t it be quite embarrassing to know that people from OUTSIDE our country are actually smarter and more instrumental at smuggling this drug in successfully and the government in charge of drug enforcement simply don’t know how to put a stop. That is embarrassing! So what a better way to shield their own embarrassment by blaming a completely different set of people as the problem — chronic pain sufferers. How inhumane. Grow some ball governmental agencies, get your act together. Figure out how to STOP this insanity of this elephant drug getting into OUR country that is the TRUE cause of killing so many people! We have an “illicit Fentanyl epidemic” — get your facts straight! Even the CDC couldn’t get their facts straight and had to recant their original testimony about this supposed opioid epidemic — their numbers are highly skewed! If we could manage to put a man on the moon nearly 60 years ago, why in God’s green earth COULD’NT we stop this deadly elephant drug from becoming so pervasive in our country? I would love to know the answer! ~ Sheri Owen Chronic pain sufferer & Sister of Vincent Winterer, just 1 tens of thousands in 2017 who died as a result of illicit Fentanyl in his system 😢 C.O.R.E. Change Opiate Regulations Emergency Don’t Punish Pain!!!

      Posted by Sharon Owen on 10/10/2018 6:40 AM

    • To titrate off pain meds oxycodone 75mg per day I had to start with gentle therapies, like cranial sacral therapy, massage therapies (classed as occupational therapy so my ins would pay) and pool therapy. The therapists at first had to move my body for me. (I was in so much pain I had to ride prone in the rear of a van to travel to the doctor.) That progressed to physical therapy for which I still needed oxycodone else I could not have done it. That progressed to exercise therapy then exercise on my own, and slowly a decrease in pain medication until I got off all pain meds in 2007 to this day, except for occasional muscle relaxers. I also had good nutritional counseling (and followed it). Nothing dramatic, but low acidic foods, no sodas, fruits, veggies. I have to emphasize you need the pain meds to progress through the pain therapies, and have to start with modalities like massage therapies, otherwise it is too painful. You could never thrust someone in my pain into PT without prior conditioning. Also, I used steroid injections and Neurontin. I had to push though the last bit of pain. I was motivated to get off, they were affecting my cognition. I have SLE and other painful autoimmune disorders, MS, peripheral polyneuropathies. It's do-able but ins has to pay for the therapies to do it. I had Medicare from disability, and Medigap from my former employer. I am back to being a hyper-productive member of society.

      Posted by Anonymous on 12/22/2018 7:43 PM

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