U.S. Senator Tammy Baldwin to Health Insurers: Step Up Response to Opioid Epidemic

WASHINGTON, D.C. – U.S. Senator Tammy Baldwin joined Senate colleagues in sending a letter, led by Senators Sherrod Brown (D-OH) and Ed Markey (D-MA), asking the nation’s top health insurers to do their part to combat the opioid epidemic. In an effort to hold the insurance industry accountable, the Senators asked the companies to both review their existing policies in light of the epidemic and to take additional steps to make sure they are doing their part to help curb addiction. 

“Unfortunately, it is often much harder for an individual to seek non-addictive pain medications or non-pharmacologic treatment options at the outset of treatment than it is to get a prescription opioid,” wrote the Senators in their letters. “In order to effectively address this ongoing epidemic, we believe insurance companies must take additional steps to ensure they are playing a more active role in addiction prevention and treatment and providing beneficiaries full access to the range of clinically appropriate services available.”

In light of the opioid epidemic, which accounted for more than 63,000 deaths in 2016, the letters ask the insurance companies to review old policies that could unintentionally be contributing to the drug addiction crisis. For example, policies like prior authorization – where a patient’s doctor must get prior approval from an insurer before prescribing a more expensive or non-formulary medication – have been in place long before today’s opioid epidemic and are well intentioned to keep costs down. But when thousands are dying each day, insurance algorithms that default to the cheapest opioid alternative could miss opportunities to turn the tide against addiction.

The letters also ask the companies what policies they have in place to make sure patients can access less addictive or non-addictive pain treatments, non-pharmacological treatments like physical therapy, and medication-assisted therapy. The Senators also pressed the companies to disclose whether they use internal controls to fight addiction, and how they identify a patient who might be struggling with addiction. The letter also asks for industry input on other factors Congress should be aware of as it considers additional legislation to address the nation’s addiction epidemic.

The Senators wrote to Aetna, AHIP, Anthem, BCBS, CareSource, Centene, Cigna, Humana, Kaiser, Molina and UnitedHealth. Read a copy of the letter here. 

In addition to Senators Baldwin, Brown and Markey, Senators Pat Leahy (D-VT), Dianne Feinstein (D-CA), Sheldon Whitehouse (D-RI), Jeanne Shaheen (D-NH), Richard Blumenthal (D-CT), Chris Murphy (D-CT), Angus King (I-ME), Tim Kaine (D-VA), Elizabeth Warren (D-MA), Chris Van Hollen (D-MD), Cory Booker (D-NJ) and Maggie Hassan (D-NH) also signed the letter.