OxyContin No Longer Covered By Some Insurers

By Beth Leipholtz 09/14/18

“This is a whack-a-mole solution... I don’t believe we should be isolating one category of opioid versus another,” said one expert.

pharmacist holding a prescription bottle

Some insurers are taking a rather bold stand against the opioid crisis by refusing coverage of OxyContin, a popular brand-name opioid painkiller. 

The decision, according to the Houston Chronicle, has drawn controversy as some people question whether refusing to cover one specific medication will really make a difference. 

“This is a whack-a-mole solution,” James Langabeer, professor of emergency medicine at McGovern Medical School at UTHealth, told the Chronicle. “On the one hand, it’s good that the insurance industry is weighing in, but I don’t believe we should be isolating one category of opioid versus another.”

OxyContin, a brand name for oxycodone, is manufactured by Purdue Pharma, a company that has faced a slew of federal lawsuits for its alleged role in fueling the current opioid crisis.

One concern, Langabeer says, is that denying access to OxyContin won’t necessarily force individuals to stop abusing opioids. In fact, he says, some may even begin using heroin instead, as it’s cheaper and more accessible.

The Chronicle reports that last week, Blue Cross and Blue Shield of Tennessee announced that it will discontinue coverage at the start of 2019, stating it was “drawing a line that we will not continue to pay for this.”

Previously, Cigna and UnitedHealthcare also announced the same

A Cigna spokeswoman told the Chronicle via email that Cigna will consider covering the medication in some situations if a doctor feels it is “medically necessary.” She added that those using the medication for hospice care or cancer treatment will be allowed to continue use.

UnitedHealthcare ceased to cover OxyContin in employer-sponsored plans beginning January 2017, according to the Chronicle.

“There are therapeutically equivalent, covered alternatives that can be used for pain indications,” a spokesman for UnitedHealthcare told the Chronicle via email.

Cigna, as well as insurer Florida Blue, will be replacing OxyContin with Xtampza, which they claim is more difficult to abuse. 

Purdue Pharma has not been silent as insurance companies have rolled out these decisions. The company, according to the Chronicle, argues that it has been working to make the medication harder to abuse. It has also accused insurers of supporting its competitors for “financial gain.”

“These recent decisions by insurance companies limit prescribers’ options to help address the opioid crisis,” a company spokesman told the Chronicle via email. “Unfortunately, these decisions appear to be more about pharmaceutical rebates.”

Katharine Neill Harris, a fellow in Drug Policy at Rice University’s Baker Institute of Public Policy, tells the Chronicle that she has mixed feelings about the involvement of insurers. 

“They do have a role and I don’t think they have done enough yet,” she said. “The easiest way to say we’re doing something is by stopping covering a drug.”

For Harris, a better alternative is for insurers and doctors to look into long-term solutions for chronic pain, such as physical therapy.

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.