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Strategies for Combating Opioid Addiction Part II

Burdine & Brown Nov. 18, 2019

In writing a few days ago I began to address the opioid crisis as seen by an insurance company nurse. This nurse had a few suggestions as to how to fight this crisis. I admit readily that there is a crisis in America over usage of opioids. What I do not like is the heavy-handedness of the insurance companies as they try to control my clients with drug formularies.

The 4th suggestion of this nurse was: Ensure opioid prescribing guidelines are followed.

This is a one-size fits all solution. The idea is to tell a worker that if he/she injures their hand and needs surgery to “fix” the problem, the physician would be authorized to prescribe a certain number of opioid medications for a limited period of time “because that is what the formulary says”. They will argue that the formulary or pill limit is based on research. This is an attempt to limits costs, not to give the worker the best medical care. Does every surgical outcome wind up the same? Do I have more residual pain following a surgical event than you have? Who is to say?

This is a prescription for litigation over what is humane, decent and right. This formulary will not drive costs down. It will create more dissatisfied patients who will now go out and hire a lawyer to sue for better medical treatment. This is not what the insurance companies want but it is what they will get if these “one size fits all” formularies are adopted in Georgia.