At White House opioid commission meeting, insurance industry gets a scolding

WASHINGTON — Patrick Kennedy, it seemed, had been waiting for a public opportunity to speak directly to the nation’s health insurers.

“The historic treatment of addiction and mental illness has been a separate and unequal process,” the former Rhode Island congressman and a member of the president’s opioid commission told a group of insurance executives on Friday. “All of you, as insurers and payers, have treated mental health and addiction as if it’s something other than the rest of medicine.”

The in-your-face scolding, delivered during a commission meeting, centered on the disparities between insurance coverage for addiction and other medical conditions. It underlined concern among other members of the commission that the insurance industry needs to take stronger action to help address the nation’s opioid crisis.

New Jersey Gov. Chris Christie, the Republican who chairs the panel, later confirmed what the representatives from insurers including Cigna, Aetna, Anthem, Kaiser Permanente, and Blue Cross Blue Shield had likely already learned they should expect from the commission’s final report, due Nov. 1.

“It’s going to be, so you’re prepared, a real call to action for all of you,” Christie told the insurance executives. “And that’s not to say that you’re not acting now. … But when 64,000 people died last year, it’s not enough. And I heard you all say that, too. But we now have to turn those words into action.”

Insurance groups sought to highlight their own progress against the opioid crisis, citing efforts to bring prescription practices in line with guidelines from the Centers for Disease Control and Prevention, reduce stigma surrounding substance use disorder, and grow networks for delivering medication-assisted treatment.

“Cigna came out 18 months ago and was proud to make a commitment to reduce commercial opioid use by 25 percent,” said Dr. Douglas Nemecek, Cigna’s chief medical officer. “Within the first year we were successful at getting halfway there, and we’re getting close to that full 25 percent reduction already. But that’s only the first of some of our goals.”

Massachusetts Gov. Charlie Baker, another member of the opioid commission, expressed frustration with comments by the insurance industry.

“I didn’t hear anybody talk about recovery coaches,” Baker said. “I didn’t hear anybody talk about how long you think somebody needs to be in treatment.”

Missing from the conversation, Baker said, was discussion of “how we’re keeping score and keeping track of how we’re actually doing.”

At a meeting last month, the opioid commission heard from representatives of the pharmaceutical industry, who have also shared blame for their role in the opioid crisis but who largely escaped the same scolding delivered to the insurance groups.

The only non-industry testimony at that hearing came from Dr. Francis Collins, the director of the National Institutes of Health, and Dr. Nora Volkow, the director of the National Institute on Drug Abuse. The NIH and NIDA have worked this year to partner with industry groups on those efforts.

The meeting Friday was also attended by three cabinet secretaries: Acting Health and Human Services Secretary Eric Hargan, Veterans Affairs Secretary David Shulkin, and Labor Secretary Alex Acosta, who appeared at Christie’s request to address his department’s role in enforcing parity law for insurers.

Rod Rosenstein, the deputy attorney general, also attended. While he mainly addressed the Justice Department’s efforts to curb fentanyl trafficking from China, Rosenstein also carefully addressed a recent Washington Post/“60 Minutes” report that resulted in Rep. Tom Marino (R-Pa.) asking President Trump to withdraw nomination for drug czar.

That report said legislation that Marino pressed on Capitol Hill weakened the Drug Enforcement Administration’s ability to crack down on suspicious shipments from drug distributors.

“Just to clarify,” Rosenstein said, “that publicity last weekend concerned DEA’s administrative authority to suspend shipments of pharmaceutical drugs, so that has not impacted our ability to prosecute criminal violations, including fentanyl [trafficking].”

He did not refute the report’s assertion that the legislation hampered other areas of DEA enforcement.

Much of the discussion surrounding the government’s response to the epidemic in recent months has focused on the potential for an emergency declaration, which President Trump on Monday said he would deliver next week.

While none of the cabinet secretaries or commission members addressed that prospect explicitly, Kennedy became animated late in the meeting when speaking of the need to deliver more overdose reversal drugs to communities and for more doctors to prescribe medication-assisted treatment like methadone and buprenorphine.

“We ought to be treating this like a FEMA response and getting the necessary medication,” Kennedy said. “If this were Ebola, we would be getting it out there to every practitioner in this country. We’d waive all the rules and we’d say get it done and start saving lives.”

“That’s what we’ve been saying,” Christie concurred.