Jerry Abrams, 64, a marketing strategist in Minneapolis, used to run marathons. Two decades of degenerative spine disease ended that. He describes losing running as “the loss of a loved one” and says having it taken away by pain “is the hardest thing of all.” On bad days he cannot get out of bed.
Opioids help, he told NPR, but he treats them warily because of the addiction risk and the chance of building up a tolerance. “I don’t ever want to be in a situation where I need surgery and need to recover and opioid medication no longer does what it needs to do,” he said.
So when the Food and Drug Administration approved Journavx, a non-opioid pill for severe acute pain, his doctor wanted him to try it. His insurer said no.
Approved for short-term pain only
Journavx is the first new kind of painkiller in more than 20 years. It works by blocking pain signals at the site where someone hurts, and doctors are cautiously optimistic that it lacks the addictive potential of opioids. About 1 in 5 Americans live with chronic pain, and the drug looked like hope for them.
The approval is narrow, though. The FDA cleared it for acute pain, usually defined as pain lasting less than three months, such as the days after surgery. Abrams has chronic pain, so his coverage was refused. Even for post-surgical patients, whom the approval studies covered, insurers have been slow.
“I think overall surgeons were very excited about the option to have a non-opioid pain medicine for our patients,” said Dr. Jessica Burgess, a surgeon at Eastern Virginia Medical School at Old Dominion University in Norfolk, Virginia. “Unfortunately, I have yet to meet a surgeon that’s been able to prescribe it.”
The price gap
Generic opioids cost a few cents a pill. Journavx runs around 15 dollars a pill, according to Dr. Antje Barreveld, president of the American Academy of Pain Medicine. She saw the difference firsthand when a relative was prescribed both drugs after surgery: “The oxycodone cost about, I think, $0.50 and the Journavx was a $30 co-pay.”
Coverage varies by state. Barreveld said it has improved in Massachusetts in recent months. Nationally, about 38% of people have coverage, said Jayne Hornung, chief clinical officer at MMIT, a pharmaceutical market data company, and that is typical for the first months after a launch. Most insurers pay for only 14 days, which matches how long the drug was studied in clinical trials. Some patients approved for a first round are refused a refill after two weeks.
Hornung put the insurers’ reasoning plainly. “We know it’s not addictive within 14 days. But what about after 14 days?” she said, asking about long-term side effects at 30 days or a year.
Abrams’s coupon
Abrams and his doctor eventually got a coupon from Vertex Pharmaceuticals, the maker. Paying himself would have cost more than $500 every two weeks; with the coupon he paid $30, but it covered only four fills. The drug did not touch the main pain in his spine. It did ease pain in his shoulder and mid-back, which he found “really interesting.”
His doctor is looking for a way to keep him on it after the coupon runs out. Vertex is running studies that could win further FDA approvals, including in diabetic peripheral neuropathy, painful nerve damage in the limbs, and lumbosacral radiculopathy, a form of low-back pain caused by a pinched nerve.
