Earlier this week we looked at an article that seemed to indicate we’ve still got a long way to go when it comes to the success of abuse-deterrent opioids. Now a new study from the healthcare advisory company Avalere points out that even though abuse-deterrent formulations are out there, payers still tend to cover generic versions of non-deterrent formulations at a greater rate than abuse-deterrent brand names.

The study looked at Medicare, because the rise in opioid abuse does not discriminate by age and even seniors are abusing pain medications. Between 2003 and 2013 the number of seniors estimated to be misusing their prescription pain medications just about tripled.

They found that Medicare Part D coverage has been declining for brand name opioids, especially abuse-deterrent versions of brand names. Between 2012 and 2015, OxyContin (an abuse-deterrent label since 2013) dropped from being covered in 61 percent of plans to 33 percent of plans. This was a larger decline rate than the coverage rates for long-acting, non-abuse deterrent formulations of opioid medications found to decline about 10 percent overall in terms of the number of plans that were covered.

The brand name Opana ER, which does not have the FDA’s abuse-deterrent label, also declined in coverage from 71 percent of plans to 48 percent of plans, but still has a higher coverage rate than OxyContin. The generic Oxycodone Hydrochloride (HCI), which is formulated for immediate release, was covered by 100 percent of Medicare Part D plans and only required prior authorization in .3 percent of plans. Part D plans require prior authorization for twenty-five percent of abuse-deterrent OxyContin. As of now, there are no generic formulations that have abuse-deterrent properties.

OxyContin is considerably more expensive than generic opiates, and seemingly insurance plans seem to favor generics even when they have no abuse-deterring properties. The Centers for Medicare and Medicaid Services (CMS) recognizes the abuse in their programs and are trying to take steps to curb it, but right now it just seems that cheaper drugs still win out even though they are not abuse-deterrent. Though as we’ve seen, just because something is abuse-deterrent doesn’t mean it is abuse-proof. Barriers on medications will not stop patients from simply swallowing a high dosage, and that is extremely dangerous too but inhalation and injection have higher rates of overdose fatalities.