As more people become addicted to painkillers, the more it costs you

Beth Orenstein | April 28, 2012

The number of people addicted to prescription painkillers such as OxyContin and Vicodin is climbing rapidly -- so much so that the Centers for Disease Control and Prevention (CDC) calls it a problem of "epidemic" proportions.

Not only is addiction to painkillers a huge safety issue, but it is also a costly one. According to the Coalition Against Insurance Fraud (CAIF), misuse of prescription painkillers is costing health insurers tens of billions of dollars each year.

The health insurers must not only cover the cost of the drugs but they also must pay for emergency room visits, rehab programs and associated health problems when patients become ill or get in trouble with the law because of their addiction.

And health insurance companies pass the costs on to all their subscribers in the form of higher premiums.

One way abusers obtain prescriptions is by "doctor shopping" -- going to different doctors to get multiple prescriptions for the same painkillers.

Health insurance companies find prescription drug abuse difficult to stop because they are required to process claims according to the subscribers' benefits.

Implementing abuse prevention

Still, many insurers are taking steps to try and prevent patients from abusing prescription painkillers.

Among the steps the insurance companies are implementing to thwart such abuses are:

  • Educating providers about the widespread problem of misuse of common prescription painkillers. Insurers remind providers that they should only prescribe strong painkillers when absolutely necessary and that they should start patients on the lowest dose possible.
  • Limiting how long prescriptions are valid. Insurers require patients who need renewal after six months to be re-evaluated by their doctors.
  • Monitoring usage with computer programs. Some insurance companies and pharmacy benefit managers use data mining programs to look for doctors, pharmacists and patients whose use of prescription painkillers may be suspicious. They alert appropriate officials when they suspect there may be a problem.

Law and drug enforcement agencies also are instituting programs to monitor potential prescription drug abuse and crack down on people who obtain multiple prescriptions for the same drug from their doctor or from different doctors. The programs track the distribution of prescription painkillers.