Key developments in 2019

Insurers in the UK took note of the headlines generated by opioids litigation in the United States. Towards the end of 2019, a first federal trial was abandoned as distributors and manufacturers came to a $260m settlement just hours before the trial was due to commence. It remains to be seen whether the remaining thousands of opioid lawsuits brought by states and local governments in the United States will proceed to trial or be resolved via negotiation.

Although not on the scale seen in the United States, the problems over opioid addiction in the UK are well documented. Opioid prescribing more than doubled in the period 1998 to 2018, as did the number of Britons taken to hospital after overdosing on opioid products. As the risks are understood better, so regulators have started to take action. The General Pharmaceutical Council in 2019 tightened guidelines relating to online prescribers. Also during 2019, an expert working group under the auspices of the Medicines and Healthcare products Regulatory Agency (MHRA) began considering steps to combat the escalating problems.

We have started to see claims arising from opioid use/over-use in the UK but it is not clear yet what the scale of litigation will be. In our view, "pinning the blame" on one component of the supply chain appears problematic, whether that is the manufacturer, distributor, prescribing clinician or dispensing pharmacist. Opioid products are regulated and widely accepted as the best medication option in certain circumstances. In any given case, the extent to which clinicians followed up with patients (particularly where online prescriptions are involved) and the extent to which manufacturers acted appropriately on performance data may vary and will be part of a complex wider picture.

Throughout 2020 the various entities in the supply chain, as well as their insurers, will continue to watch developments in the United States, as well as investigations such as the MHRA's, with interest.

What to look out for in 2020

As the public grows increasingly frustrated with difficulties in obtaining GP appointments, we expect telemedicine to become even more popular during 2020 and for there to be an increase in demand for insurers to cover such services. People are becoming more accustomed to accessing health services remotely, at a time of their choosing, and paying for it.

The law governing telemedicine is derived from a patchwork of EU regulations, national laws and guidance published by regulators. Underwriters should scrutinise providers to ensure they are compliant.

Insurers of companies providing a telemedicine service, such as via a website, will want to check that companies adhere to the legislation governing the supply of medicines over the internet. Insurers of clinicians providing a telemedicine service, such as doctors contracted by a website provider, will want to ensure that they are compliant with their duties over remote consultations and the online prescribing of drugs.

Issues over online opioid prescribing illustrate the need for prescribers, website hosts and dispensing pharmacists to be alert to the particular challenges posed by online consultations and remote prescribing of drugs. The companies that get it right will tap into a growing market in 2020.