Oregon Considering Nation’s Most Dramatic Prescription Opioid Coverage Cut For Medicaid Patients With Chronic Pain

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Evie Fordham Politics and Health Care Reporter
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Oregon is considering slashing prescription opioid coverage and weaning Medicaid chronic pain patients off of opioids by 2021 as part of a proposed policy that would be the most restrictive in the nation.

The Oregon Health Plan is considering a proposal that would force Medicaid patients who want prescription opioid coverage to taper their dosages to zero from 2020 to 2021. The proposal, which could be approved as early as October, would apply to patients with one or more of “five broad chronic pain conditions,” reported the Bend Bulletin.

Oregon’s state Medicaid program does not cover treatments for the five chronic pain conditions, which include fibromyalgia, chronic postprocedural pain and trauma-related chronic pain. Under the proposal, Medicaid would cover those conditions with treatments like acupuncture, physical therapy or even yoga.

However, chronic pain patients who wanted Medicaid to cover long-term opioid prescriptions would need to taper. Right now, Oregon’s Medicaid program is covering opioid prescriptions for many of those patients because state Medicaid “has no way of knowing whether those patients are being prescribed opioids for those chronic pain conditions or for covered services,” reported the Bend Bulletin.

“It is important to note that this policy would not be universal,” an Oregon Health Authority spokeswoman told STAT via email. “If doctor/patient felt that the taper was inappropriate because of the specific circumstances and comorbidities for that patient, an exception could requested and made by the plans.”

Although the state’s overdose rate was only half of the nation’s average in 2016, its doctors prescribe opioids at a rate “slightly higher” than the national average, according to 2015 numbers cited by STAT.

The state did not say how many people the proposal could affect, but 1 million Oregon residents have Medicaid, and approximately 11 percent of U.S. adults have chronic pain according to the National Institutes of Health.

Critics of the proposal say that cutting patients off from painkillers could make them turn to illegal drugs or consider suicide, reported STAT. Critics also point out that there is “little research to suggest that tapers, particularly forced tapers, improved outcomes for patients,” reported the Bend Bulletin. (RELATED: Trump Administration Health Officials Push Cheaper Off-Exchange Health Plans For Middle-Income Americans)

“What is notably missing is any review of any literature regarding the centerpiece of their proposed policy: Forced opioid taper to zero for all persons,” Dr. Stefan Kertesz, a pain and addiction specialist at the University of Alabama in Birmingham, told STAT.

Follow Evie on Twitter @eviefordham.

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