Paying the Piper
By now, nearly everyone is aware of the enormous toll the opioid epidemic has taken on our society. What’s not generally known, and needs to be investigated, is who is responsible for the overdose deaths, addiction, and crime that resulted when addicts realized that heroin is a cheaper alternative to the prescription drugs they were given.
We should certainly start with the pharmaceutical vendors who put profit above overall health and safety. But it’s also worth recognizing the role that insurers and reimbursement agencies played when they denied coverage for alternative pain therapies—including some forms of neurmodulation—and instead gave the nod to pain pills, which seemed cheaper at the time but now have proven vastly more expensive. Neuromodulation devices will almost always appear to be more expensive than drugs if you just look at up-front cost.
Given their track record, one would think that the alternative pain therapy deniers would be hiding under a rock someplace. But chutzpah is at a premium these days. The American College of Occupational and Environmental Medicine, which was successful in getting workers comp coverage for neuromodulation devices denied in other states, has begun a new effort to do the same in California, despite its failure two years ago. The state’s Division of Workers’ Compensation is now considering changes to its guidelines pushed by ACOEM to eliminate coverage for SCS. Several physicians groups, including the American Pain Society, the American Academy of Physical Medicine and Rehabilitation, and the American Society of Anesthesiologists, oppose the ACOEM guidelines and believe they could lead to even more opioid deaths in the future.
ACOEM, which has been described as a front for the insurance industry, continues to claim there is insufficient evidence for neuromodulation therapies, despite the wealth of new studies, new methodologies, and new regulatory approvals. Abbott vice president Mark Carlson contends ACOEM misrepresented the results of one key study on SCS for low back pain. ACOEM’s board of directors includes several corporate and insurance industry representatives. Its incoming president highlights his efforts defending asbestos manufacturers on his website for consulting services.
There’s nothing wrong with the idea of reducing medical costs for insurers and employers. But ACOEM should be honest and straightforward in its recommendations and they should look at overall, long-term costs, not just the upfront pricetag on a bottle of pills or a neurostimulation device. A guideline that saves insurers and employers a few dollars in the short term but pushes massive long-term costs on to everybody else is neither financially prudent nor medically ethical.
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