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many of our patients decide not to have them. Reimbursement for psy- chological care is almost nonexistent for patients with chronic pain.” He recommends health plans help


make those types of alternatives more readily available to patients. “It is ironic that health plans now


want to demand prior authorizations for opioids and other controlled sub- stances in new patients, but if ap- proved, they want physicians to write prescriptions for a three-month sup- ply,” he said.


Looking at it from a psychiatrist’s perspective, Dr. Secrest questions whether behavioral health disorders associated with chronic pain are being SNOX^S ON KXN KNO[_K^OVc KNN\O]]ON “If you’re not addressing the de-


pression that’s there, then quite often managing pain is going to be a chal- lenge,” he said. “It’s these comorbid conditions that you ask us to begin to identify and begin to have strategies to treat those sorts of things.” But Dr. Watson said Cigna’s opioid policies have been “going very well.” “I’ve spoken personally with a few


groups to clarify the prior authoriza- tion quantity limit changes and have not had any negative feedback regard- ing those changes,” he said. Cigna announced in April, about


a year after its stated commitment to decrease customers’ opioid use by 25 percent by 2019, that customers’ use had already fallen 12 percent. In May, Aetna announced a 7-percent reduc- tion in its monthly opioid prescription rate since August 2016. “This is a societal problem,” Dr.


Watson said, “and when you have 91 people dying every day from an opioid overdose in the United States, this is something that all of health care has to be concerned about and take steps against preventing those needless deaths.” Q


Joey Berlin is associate editor for Texas Medicine. You can reach him by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370- 1629; or by email at joey.berlin@texmed.org.


42 TEXAS MEDICINE November 2017


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