Rep. Cummings Requests Documents From Top Insurers and Pharmacy Benefit Managers on Limiting Access to Less Addictive Opioids

WASHINGTON, Oct. 19 -- Rep. Elijah Cummings, D-Md., ranking Democratic member of the House Oversight and Government Reform Committee, issued the following news release:

Today, Rep. Elijah E. Cummings, the Ranking Member of the House Committee on Oversight and Government Reform, sent letters to UnitedHealth Group (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20United-Optum%20re.%20Insurers%20and%20PBMs.pdf), Optum, Humana, CVS Health, Aetna, Anthem, and Express Scripts requesting documents and information about recent reports that insurance companies and pharmacy benefits managers (PBMs) are limiting patient access to less addictive pain therapies while making it easier for patients to access cheaper, more addictive opioids.

"Insurers and PBMs have developed initiatives to address the opioid epidemic, but this new report indicates that fundamental financial incentives may be driving insurers and PBMs to steer beneficiaries to the very drugs that are fueling the opioid crisis," Cummings wrote.

Last month, the New York Times and ProPublica conducted an in-depth investigation (https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html) finding that most prescription drug plans offered under the Medicare Part D prescription drug benefit cover common prescription opioids without limitation, while only one-third of people covered by these plans had similar access less addictive opioids.

The report also found that when plans do cover non-addictive opioids, they often require patients to go through extra hurdles, such as obtaining prior approval from insurance companies before receiving treatment, and they place less addictive drugs on higher cost-sharing tiers.

"This is not a hypothetical problem," Cummings wrote, adding that "prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses."

In 2016, there were 418 prescription opioid-related deaths in Maryland alone--an increase of 19% since 2015.

Cummings requested that the companies provide lists of all brand and generic medications for each insurance or prescription drug plan the companies offer, the cost-sharing tiers on which the medications are placed, and whether the drugs are non-narcotic or narcotic/opioids.

Click the links below to read today's letters.

UnitedHealth Group (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20United-Optum%20re.%20Insurers%20and%20PBMs.pdf)

Optum, Inc. (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20United-Optum%20re.%20Insurers%20and%20PBMs.pdf)

Humana, Inc. (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20Humana%20re.Insurers%20and%20PBMs.pdf)

CVS Health (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20CVS%20re.Insurers%20and%20PBMs.pdf)

Aetna, Inc. (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20Aetna%20re.%20Insurers%20and%20PBMs.pdf)

Anthem, Inc. (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20Anthem%20re.%20Insurers%20and%20PBMs.pdf)

Express Scripts (https://democrats-oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2017-10-19.EEC%20to%20Express%20Scripts%20re.Insurers%20and%20PBMs_0.pdf)