Are health-care reimbursement policies a barrier to acute and cancer pain management?

US health-care policy and recent literature are reviewed to examine whether there are reimbursement barriers to acute and cancer pain management. The available evidence suggests that lack of coverage and uneven reimbursement policies for health care including prescription drugs, medical equipment, and professional services inhibit access to acute and cancer pain management for millions of citizens, in particular the poor, elderly, and minorities. Medicare, Medicaid, and HMO issues are reviewed. Available evidence suggests that the use of "caps" on prescription drugs limits access to pain medications. Access to the opioid analgesics that are essential to pain management is limited by some state-controlled substances regulations and by some mail-order pharmacy policies. Controlled substances laws appear to create financial disincentives for pharmacies and hospices. Programs to help indigent patients obtain opioid analgesic medications are reviewed. Suggestions are offered for hospices to reduce costly waste of analgesic medications that remain after patients die. Reimbursement for acute and cancer pain management should be reviewed and included in current efforts to reform national health-care policy.