by
Louis E. Baxter, MD, FASAM
| September 25, 2012
Over the past few years since the National Institute of Health has brought us proof that addiction is a “Brain Disease,” and since effective counseling strategies and effective medications have been developed, we find that payers are quickly creating “new” barriers and hurdles that our patients must overcome to access the benefits from years of research and development. Addiction is recognized as a chronic medical illness like diabetes, hypertension and asthma. Yet, patients are not always able to access the treatment that is required as determined by the physician. There are road blocks concerning the level of care a patient can access not in keeping with ASAM PPC-2R. There are hurdles regarding prior authorizations before medication can be prescribed, and then there is the burden of “hurry up and get off” the efficacious lifesaving medications, as though chronic medical illness are curable!
No one cajoles diabetics off insulin. No one tells hypertensive patients that they only are on medication for six months to one year before their prescription benefits are terminated. Certainly, no insurer tells an asthma patient that their daily dosage of medication is limited to a pre-selected amount, even if they continue to be symptomatic. No insurer does that to any other patient except people that suffer from addiction. In fact, the treatment that patients with addiction receive in terms of their insurance benefit for addiction treatment is like punishment for willful misconduct rather than compassion for a chronic disease.
The paper “The Impact of Managed Care on Addiction Treatment: An Analysis” reviews these and other issues and offers some recommendations that would improve this situation. Please read it and tell me what you think.