Stains Outlast Gains as Industry Encroaches on Physician Prescribing Power

Posted on | December 15, 2017 | Comments Off on Stains Outlast Gains as Industry Encroaches on Physician Prescribing Power

Opioid Czar & Czarina

Mike Magee

When the AMA helped empower Purdue Pharma funded Pain Management by granting specialty status in its’ Federation in the 1980s– and with that legitimacy of pain as the “5^th vital sign”; and when everyday physicians (especially primary care physicians who were targeted by Purdue Pharma) became easy marks in a deadly nationwide narcotics scam – the profession was unwittingly risking their primary differentiator and economic lever, prescribing power.

Now, some three decades later, the crow has come home to roost. And government under Trump will not come to the rescue. The White House Council of Economic Advisers has placed the cost per year of the epidemic at $500 billion. Chris Christie found a “life-after-Trump” with the issue. Now, following the lead of putting Jared in charge of Middle East peace, Trump has assigned opioids to an equally unprepared Kellyanne Conway who has created an “opioids cabinet” as the first, and likely the final contribution she’ll make to solving this crisis.

In the meantime, the insurance industry has taken a break from its’ latest land grab at vertical integration (looking at you Aetna-CVS and United Healthcare-DaVita), and is putting the breaks on MD prescribing.

Aetna is all in on cutting off the spigot, stating that “Aetna is committed to addressing the opioid crisis through prevention, intervention, and treatment.” As for the details, look to Cigna and Anthem. They have both set up restrictions on number, frequency and location of opioid prescribing intended to deliver near immediate 30% decreases in the pharmacy enabled narcotic trade.

Anthem marketers make the whole mess sound like a “win-win”. Commenting on an Anthem supported effort to use combined therapy for opioid addicts in Connecticut, Sherry Dubester, their VP of Behavioral Health, says, “I think that’s a great example of where the payer side can find providers doing interesting things and innovative approaches, and look to embrace that early.” Sounds wonderful!

As for prescribing leadership, PhRMA is ready to fill the void as well (as long as it doesn’t interrupt their current focus on price hikes and job cuts to enhance profitability. Their just released policy includes 1) Prescription limits of a 7 day opioid supply for acute pain and a 30 day supply for chronic pain, and 2) prohibition on opioid prescribing in an office setting.

Short-term thinking often has long-term implications. Whether it’s open-ended entry into the AMA Federation as a membership-enhancement strategy, MD’s fast-pen prescribing so easily manipulated by industry, or the support of physician politicians who are clearly ethically compromised, the stains last a great deal longer than the government relations gains.

Trust must always be earned. That takes time and consistency.