美国国家公共电台 NPR Insurance Rules Can Hamper Recovery From Opioid Addiction

Insurance Rules Can Hamper¹ Recovery From Opioid Addiction²

STEVE INSKEEP, HOST:

The roadblock to attacking the drug addiction crisis - it is hard for people to get medications that help them recover, hard even if they have insurance. Drugs like Suboxone are supposed to address addictions³ to heroin⁴ and painkillers⁵. Here's Jake Harper of Side Effects Public Media.

JAKE HARPER, BYLINE⁶: Twice a day, Angela and Nate Turner take a tiny strip that looks almost like colored scotch⁷ tape and put it under their tongues.

ANGELA TURNER: They taste disgusting.

HARPER: She says it's worth it. That strip is actually a drug called Suboxone. The married couple got addicted⁸ to painkillers several years ago following separate injuries. They both decided⁹ to go into recovery this year. Suboxone helps them control their cravings.

A. TURNER: Just don't have them withdrawals¹⁰ and you feel normal. But you're not high. It's like a miracle drug, really, it is.

HARPER: Angela can take care of their 3-year-old daughter and Nate can keep a job. They don't have to think about how they'll get drugs or how sick they'll feel if they don't. But getting started on Suboxone took time. Angela says she had to wait three days to get her prescription¹¹ filled, which put her into withdrawals.

A. TURNER: Lying in bed going through cold sweats, hot sweats...

NATE TURNER: Diarrhea.

A. TURNER: ...Diarrhea, legs aching, pain.

HARPER: For Nate, the wait was five days. On day three, he relapsed and used heroin.

N. TURNER: I swore to myself I was done so that when - and then when I went back to having to use it, I just thought it was over, that I wasn't going to make it back to the program.

HARPER: Suboxone is covered through the Turners' health insurance plan, which is part of Indiana's Medicaid. But before their insurance company will pay for it, doctors and nurses have to get approval known as a PA, prior authorization¹². The process frustrates¹³ Andy Chambers¹⁴, an addiction psychiatrist¹⁵ in Indianapolis.

ANDY CHAMBERS: This will include phone calls, filling out forms, sometimes writing essays, going through appeal processes.

HARPER: He says his nurses spend about 30 hours a week on all this.

CHAMBERS: It's almost like when you take on a patient to treat Opiate addiction, you also have to take on another patient called the insurance company.

HARPER: Getting a prior authorization can take days or weeks depending on the drug and the insurance company. PA requirements can also pressure doctors to change how they prescribe. Sometimes an insurer will push for a lower dosage than the doctor wants or it'll require the doctor to wean a patient off of a medication sooner than the doctor would recommend.

CHAMBERS: These rules and regulations for us completely block the correct provision of care. And that's crazy.

HARPER: And for some insurers, a prior authorization expires after just a few months. Indiana Medicaid has started to allow some doctors to skip that initial back and forth¹⁶ with the insurance company. But Chambers says it hasn't helped him much yet. Sam Muszynski is with the American Psychiatric Association. He says patients are vulnerable during these delays.

SAM MUSZYNSKI: You may lose that opportunity right then and there. They may never come back.

HARPER: He and other experts say the use of prior authorizations for addiction medications is widespread. As of 2013, Medicaid in 48 states required a PA to prescribe Buprenorphine, the active ingredient in Suboxone.

MUSZYNSKI: There's a continuing pattern of discrimination, which results in reduced access to people who need Opioid addiction treatment.

HARPER: Muszynski says the use of prior authorizations is one way insurers limit what they pay for. And they use PAs more often with mental health and addiction treatments compared to other medical treatments. Nate Turner has managed to stay in treatment despite the prior authorization process. He says there's an irony¹⁷ here.

N. TURNER: I can assure you if I was on regular pain medicine, I'd be able to get them no problem.

HARPER: He says he got started on Opioids without a prior authorization. He shouldn't need one to help him stop. For NPR News, I'm Jake Harper in Indianapolis.

INSKEEP: That story's part of a reporting partnership with WFYI and Kaiser Health News

1 hamper   

vt.妨碍，束缚，限制；n.(有盖的)大篮子

参考例句：

• There are some apples in a picnic hamper.在野餐用的大篮子里有许多苹果。
• The emergence of such problems seriously hamper the development of enterprises.这些问题的出现严重阻碍了企业的发展。

2 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

3 addictions   

瘾( addiction的名词复数 )； 吸毒成瘾； 沉溺； 癖好

参考例句：

• He has removed the stigma of drug addictions. 他已经洗去吸毒的污点了。
• Intelligent people are good at using reason to control excessive addictions. 智慧的人善于用理性来控制过度的嗜欲。

4 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

5 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

6 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

7 scotch   

n.伤口，刻痕；苏格兰威士忌酒；v.粉碎，消灭，阻止；adj.苏格兰(人)的

参考例句：

• Facts will eventually scotch these rumours.这种谣言在事实面前将不攻自破。
• Italy was full of fine views and virtually empty of Scotch whiskey.意大利多的是美景，真正缺的是苏格兰威士忌。

8 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

9 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

10 withdrawals   

n.收回，取回，撤回( withdrawal的名词复数 )；撤退，撤走；收回[取回，撤回，撤退，撤走]的实例；推出（组织），提走（存款），戒除毒瘾，对说过的话收回，孤僻

参考例句：

• He has made several withdrawals from his bank account. 他从银行账户上提了几次款。 来自《简明英汉词典》
• It is not the bank's policy to deduct interest on withdrawals. 提款需扣除利息这并非是本银行的政策。 来自辞典例句

11 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

12 authorization   

n.授权，委任状

参考例句：

• Anglers are required to obtain prior authorization from the park keeper.垂钓者必须事先得到公园管理者的许可。
• You cannot take a day off without authorization.未经批准你不得休假。

13 frustrates   

v.使不成功( frustrate的第三人称单数 )；挫败；使受挫折；令人沮丧

参考例句：

• What frustrates him is that there's too little money to spend on the project. 使他懊恼的是，可用于这个项目的资金太少。
• His trouble is that he frustrates much easily. 他的毛病是很容易泄气。 来自《现代汉英综合大词典》

14 chambers   

n.房间( chamber的名词复数 )；（议会的）议院；卧室；会议厅

参考例句：

• The body will be removed into one of the cold storage chambers. 尸体将被移到一个冷冻间里。 来自《简明英汉词典》
• Mr Chambers's readable book concentrates on the middle passage: the time Ransome spent in Russia. Chambers先生的这本值得一看的书重点在中间：Ransome在俄国的那几年。 来自互联网

15 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

16 forth   

adv.向前；向外，往外

参考例句：

• The wind moved the trees gently back and forth.风吹得树轻轻地来回摇晃。
• He gave forth a series of works in rapid succession.他很快连续发表了一系列的作品。

17 irony   

n.反语，冷嘲；具有讽刺意味的事，嘲弄

参考例句：

• She said to him with slight irony.她略带嘲讽地对他说。
• In her voice we could sense a certain tinge of irony.从她的声音里我们可以感到某种讥讽的意味。