The Opioid Crisis: Who’s Going to Pay?

Lawsuits related to the opioid crisis have now begun to flood the U.S. court system. First were the suits filed by victims and their families, and the price tag for those was, is and will continue to be large. Those awards and settlements are quite likely to be dwarfed by the sums sought by states and local governments looking for compensation for the billions of dollars they have had to spend in dealing with the crisis itself, not to mention its collateral effects like its impact on law enforcement.

Insurance companies are very likely to face much of the blame according to a front page story in today’s New York Times. In a joint investigation with Pro Publica, the Times reports that major insurance companies directed patients to lower cost opioids instead of more effective but also more expensive alternatives. An analysis of Medicare drug prescription plans, covering 35.7 million people, found that insurers steered people to opioids, often not requiring prior approval or that they try other alternatives first. The study found, for example, that only one-third of those covered had access to Butrans, a skin patch that contains a less addictive opioid. Another drug, lidocaine, which is not addictive but costs more than many opioids requires prior approval. Ironically, many insurers have made it more difficult for people to receive addiction treatment than to obtain the addictive drugs.

In what is likely to be a sign of things to come the New York State Attorney General’s Office has sent letters requesting information to the nation’s three largest pharmacy benefit managers, CVS Caremark, Express Scripts and OptumRx. Until now most of the attention of courts, plaintiffs and lawmakers has been on physicians, drug makers and distributors. That calculus is likely to change as plaintiffs pursue deep pockets and defendants look to apportion the blame and literally to pass the buck.