Cigna To End Coverage Of Popular Painkiller

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Cigna To End Coverage Of Popular Painkiller

By Paul Fuhr 10/10/17

The decision is part of Cigna’s aggressive strategy to help curb prescription painkiller abuse by 25% by 2019.

Image: 
oxycontin sitting on the shelf in a pharmacy.

Insurance goliath Cigna may have finally delivered a major blow to the opioid epidemic. According to CNBC, Cigna will no longer cover OxyContin prescriptions for customers insured through their jobs, starting in January.

The decision is part of Cigna’s aggressive strategy to help curb prescription painkiller abuse by 25% by 2019. OxyContin, the brand name for a long-acting version of oxycodone, has long been criticized for being one of the major contributors to the opioid crisis. “Our focus is on helping customers get the most value from their medications—this means obtaining effective pain relief while also guarding against opioid misuse," Cigna’s chief pharmacy officer Jon Maesner said. 

Cigna’s decision doesn’t stop there, either. The insurer will continue to cover an oxycodone alternative (Xtampza ER), but will level penalties against its manufacturer, Collegium Pharmaceutical, if the drug gets used too much.

“Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold,” Cigna said. “If the threshold is exceeded, Collegium will reduce the cost of the medication for many of Cigna's benefit plans.”

Purdue Pharma, OxyContin’s manufacturer, is currently weathering a number of lawsuits after being accused of playing a role in triggering the opioid epidemic. (Purdue has denied the lawsuits’ claims while maintaining that its drugs only account for 2% of all opioid prescriptions.) 

The Centers for Disease Control and Prevention (CDC) reported in 2015 that there were over 33,000 deaths caused by prescription opioids, heroin and fentanyl. Half of those deaths involved a prescription painkiller, the CDC said. While Cigna claimed that it was “not specifically singling out OxyContin,” the drug is the only prescription painkiller it is removing from its coverage.

Cigna’s Maesner says that the insurer would examine OxyContin prescriptions on a case-by-case basis to determine which ones are “medically necessary.” Still, Cigna has already begun notifying its customers who have OxyContin prescriptions (and their doctors) that the drug won’t be covered in 2018 "so that [customers] have time to discuss treatment options and covered oxycodone clinical alternatives.” The insurer did, however, add that people using OxyContin for hospice care or cancer treatments would have their prescriptions filled.  

Purdue Pharma is unhappy with Cigna’s decision. A spokesperson noted that there are scant few differences between OxyContin and Xtampza ER. Both drugs are equally designed to deter abuse and have the same level of effectiveness.

“We believe that patients should have access to FDA [Food and Drug Administration]-approved products with abuse deterrent properties," Purdue said. “Unfortunately, Cigna's decision limits the tools prescribers can use to help address the opioid crisis as both products are formulated with properties designed to deter abuse.”

Cigna countered that the point isn’t to eliminate OxyContin so much as changing prescription practices overall. The insurer hopes that doctors will begin to prescribe drugs like Xtampza ER “in lesser quantities and for lesser amounts of time.” 

Truth be told, however, Cigna’s decision may have less to do with the opioid crisis than it does its bottom line. “I think it's important to recognize that insurers are trying to find the sweet spot between finding the right spot clinically and the right thing to do for their business,” said Dr. Caleb Alexander, director of the Johns Hopkins Center for Drug Safety and Effectiveness, CNN reported.

In fact, Alexander raises some compelling questions about the power of insurance companies. By removing OxyContin from its list of covered drugs, Cigna hasn’t just made a decision that affects the opioid crisis—they’ve sent a clear signal to Americans everywhere that insurers will continue to shape the very nature of medical care.

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