Open letter to the Insurance Industry

I would like to acknowledge Carmen “O”, an employee of HealthNet insurance company, for encouraging me to write this.  My son has been a heroin addict for nearly  5 years.  He was recently homeless in Los Angeles and in and out of ER’s.   That’s what heroin addicts who are type 1 diabetics do.  They use and do anything to get what they need.  They ignore diabetic management.  Frequently they collapse on the street in a diabetic condition called DKA (diabetic keto-acidosis) and end up in an ambulance.   The ER system is ill equip to deal with addiction, but someone has to pay the bills;  again and again.   I won’t take your time with the stories of the many attempts at trying to solve the problem via treatments centers, pleas for help, methadone, detox attempts, jails, and so on.   I do want to say that I sought suboxone treatment “early” through insurance and it was rejected as substance abuse treatment.  This kind of treatment and its medications such as suboxone are exclusions in most insurance policies.  Not knowing enough about the benefits of suboxone, I tried less expensive methods such as methadone, tough love and letting the jail  and conventional hospital systems do their part.  Methadone, by the way never worked for this addict.  That’s a long story, but basically it’s a much more powerful drug than suboxone and it is so tightly managed that many of the young addicts will not follow the regimen that methadone clinics impose.  State law requires that an opiate addict be dropped and reinstated in order to see what other drugs are impacting the addict.  So, many stay on the streets and are reluctant to seek reinstatement.  Vicious circle!  I decided, to take another look at suboxone  and pay for it out of pocket.

The suboxone clinic I found in  Tucson was responsive and  inexpensive at $190 for the first month of management.  However, most insured can not afford adding in the cost of the drug suboxone.   Insurance companies will eventually have to start covering these costs as a result of the insurance parity act which takes effect 1/1/10 for group plans of 50 or more.  It would behoove insurance companies to embrace suboxone.  The money saved by quickly stopping the street use of heroin can be staggering.  Much of the saving can be realized by the insurance companies themselves.  HealthNet now has an opportunity to lead the way.   The cost savings are especially  true in the case of heroin addicts with dangerous dual diagnosis of another disease or mental illness,  simply from the standpoint of greatly reducing the need for ER service.   Oddly enough, insurance companys  cover a week of detox in a hospital setting.  I don’t have to tell you what that costs.  This rarely works for heroin addicts.  Most will leave and relapse.  A week of anything is ineffectual to an opiate addict.  The chemical structure of their brains are basically re-structured due to their drug use and are wired to relapse.  (source:  The Neurobiology of  Addiction by George Koob )  Suboxone is by far the best, safest and least expensive treatment for a heroin addict. They can  remain on this medication for a period of time sufficient to allow the neurology of their brains to make a slow and invested transition back to some level of normalcy.  The street cost for 6 months of suboxone treatment and management can be as low as $2400 for a new addict and  $4800 for an addict on a 24mg daily regimen of suboxone per day.  The cost for repeated ER and hospitalized detox can be 5 to 10 times that amount with one occurrence of ER and a five day detox.

William Ford,