By Anusha Roy (September 30th, 2019)
DENVER — A copay could be the tipping point for someone to become addicted to opioids, depending on a patient’s health insurance, according to Dr. Jonathan Clapp, a pain specialist with Porter Adventist Hospital. He said he’s seen this problem first-hand.
“Say a patient comes into my office, and they have a knee problem that could be addressed with physical therapy. If we could work on strengthening and flexibility, we could fix the problem,” he said. “But because it can sometimes cost $80 out-of-pocket for every physical therapy session, it’s really hard for someone to afford that.”
That’s when doctors get caught between trying to treat pain and not bankrupting their patients, according to Clapp.
“Before we can get other things approved, and wait two or three days in a best-case scenario to get the right medicine, we still had to expose them to these medications, and it may have just ruined their life,” Clapp said. “It’s very hard for us to live with.”
For two years, Clapp reached out to lawmakers to change this, and in the process, he began working with State Rep. Chris Kennedy (D-Lakewood) to work on a potential new law that would change insurance policies in Colorado that are regulated by the state.
Kennedy said one prong of the proposal would work on making non-opioid medication and less-addictive opioid medications more affordable.
“Oxycodone would probably still be cheaper, but the hope is we are closing the gap,” Kennedy said.
The second prong would include giving the Colorado Division of Insurance the authority to identify other treatments like physical therapy, occupational therapy and acupuncture as good alternatives for pain that might otherwise lead to an opioid prescription.
The goal, according to Kennedy, is to require insurance companies to make these kinds of treatments more affordable, including limiting out-of-pocket costs and insurance deductibles.
Kennedy said physical therapy is considered an essential health benefit under the Affordable Care Act, so it’s offered in every Colorado insurance plan right now. but the concern is the cost.
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