Naloxone-insurance:¬†Isela was denied life insurance because her medication list showed a prescription for the opioid-reversal drug naloxone. The Boston Medical Center nurse says she wants to have the drug on hand so she can save others. (Jesse Costa/WBUR)
Martha Bebinger, WBUR
Bloodwork was supposed to be the last step in Isela‚Äôs application for life insurance. But when she arrived at the lab, her appointment had been canceled.
‚ÄúThat was my first warning,‚ÄĚ Isela said. She contacted her insurance agent and was told her application was denied because something on her medication list indicated that Isela uses drugs. Isela, a registered nurse who works in an addiction treatment program at Boston Medical Center, scanned her med list. It showed a prescription for the opioid-reversal drug naloxone ‚ÄĒ brand name Narcan.
‚ÄúBut I‚Äôm a nurse, I use it to help people,‚ÄĚ Isela told her agent. ‚ÄúIf there is an overdose, I could save their life.‚ÄĚ
That‚Äôs a message public health leaders aim to spread far and wide. ‚ÄúBe prepared. Get Naloxone. Save a life,‚ÄĚ was the message at the top of a summary¬†advisory¬†from the U.S. surgeon general in April.
But some life insurers consider the use of prescription drugs when reviewing policy applicants. And it can be difficult, some say,¬†to tell the difference between someone who carries naloxone to save others and someone who carries naloxone because they are at risk for an overdose.
Primerica is the insurer Isela said turned her down. (NPR and KHN have agreed to use just Isela‚Äôs first name because she is worried about how this story might affect her ongoing effort to get life insurance.) The company said it can‚Äôt discuss individual cases. But in a prepared statement, Primerica noted that naloxone has become increasingly available over the counter.
‚ÄúNow, if a life insurance applicant has a prescription for naloxone, we request more information about its intended use as part of our underwriting process,‚ÄĚ said¬†Keith Hancock, the vice president for corporate communications. ‚ÄúPrimerica is supportive of efforts to help turn the tide on the national opioid epidemic.‚ÄĚ
After Primerica turned her down, Isela applied to a second life insurer and was again denied coverage. But the second company told her it might reconsider if she obtained a letter from her doctor explaining why she needs naloxone. So, Isela did contact her primary care physician ‚ÄĒ and then realized that her doctor had not prescribed the drug.
Isela bought naloxone at a pharmacy. To help reduce overdose deaths,¬†Massachusetts¬†and¬†many other states¬†have established a¬†standing order¬†for naloxone ‚ÄĒ one prescription that works for everybody. Isela couldn‚Äôt just give her insurer that statewide prescription; she had to find the doctor who signed it. As it happens, that physician ‚ÄĒ¬†Dr. Alex Walley¬†‚ÄĒ also works at Boston Medical Center.
Walley is an associate professor of medicine at Boston University; he also works in addiction medicine at Boston Medical Center and is the medical director for the Opioid Overdose Prevention Pilot Program at the Massachusetts Department of Public Health.
‚ÄúWe want naloxone to be available to a wide group of people ‚ÄĒ people who have an opioid use disorder themselves, but also their social networks and other people in a position to rescue them,‚ÄĚ Walley said.
He said he has written a half-dozen letters for other BMC employees denied life or disability insurance because of naloxone, and that troubles him.
‚ÄúMy biggest concern is that people will be discouraged by this from going to get a naloxone rescue kit at the pharmacy,‚ÄĚ Walley said. ‚ÄúSo this has been frustrat