By deterring individuals who want to crush or dissolve pain medications, abuse-deterrent formulations can limit certain forms of misuse. For specific patient populations, particularly patients who live with former or current abusers or with teenagers who might seek these medications for recreational use, these formulations provide unique value.
In particular, safeguards should exist to prevent the patient’s pharmacist from dispensing a traditional version of the pain medication if the physician considers an abuse-deterrent form necessary.
To that end, insurance policies should acknowledge physicians’ judgment about which formulation a patient needs. Public policy should limit the use of prior authorization requirements or “fail first” policies that impede physicians from prescribing abuse-deterrent formulations.
Health plan benefit design must also support patients’ access to these formulations. Payers should offer coverage that’s equally favorable to that provided for traditional formulations so that exorbitant cost-sharing requirements do not price patients out of access to abuse-deterrent formulations.
Find out if there is proposed legislation in your state and take action.