What If Insurance Companies Stopped Covering Opioid Prescriptions?

There competence be a new proceed to quarrel a opioid epidemic.

Encourage word companies to stop covering a cost of some remedy painkillers. In particular, those with aloft sip levels.

Cigna Health Insurance has taken a step in that direction. At slightest with one drug.

The health insurer announced progressing this month that it will no longer cover many prescriptions for a opioid painkiller OxyContin.

Instead, it’ll switch to Collegium Pharmaceutical’s Xtampza ER. It’s another oxycodone-derived drug with reduction intensity for misuse.

Cigna pronounced it has sealed a understanding with Collegium dictated to inspire physicians to allot revoke doses of Xtampza ER.

“Cigna is intentionally aligning with stakeholders — including doctors, inhabitant and internal organizations, and drug manufacturers — who share a goal to revoke a inapt and nonessential overuse of opioids,” Karen Eldred, a Cigna spokesperson, told Healthline.

Last year, Cigna announced a goal of shortening a customers’ opioid use by 25 percent in 3 years.

“Our concentration is on assisting business get a many value from their drugs — this means receiving effective pain service while also guarding opposite opioid misuse,” Jon Maesner, PharmD, Cigna’s arch pharmacy officer, pronounced in a press release.

No longer a ‘preferred drug’

OxyContin will be forsaken from Cigna’s list of elite drugs as of Jan. 1.

Patients who’ve already started holding a drug for hospice caring or cancer diagnosis will still be means to continue holding OxyContin via 2018.

“As with other drugs that are not on lonesome drug lists, Cigna will cruise commendatory coverage for OxyContin if a customer’s alloy feels that diagnosis regulating OxyContin is medically necessary,” Cigna pronounced in a press release.

OxyContin contains a stronger sip of oxycodone than Xtampza ER. That means it can be taken reduction frequently. But a aloft sip creates OxyContin some-more expected to be misused, experts told CNN.

In addition, abrasive or melting some extended-release pills can be one day’s value of sip in only one pill.

Cigna officials contend Xtampza ER is formulated to conflict attempts to cut, crush, or gnaw a pills to obtain a higher, evident sip of oxycodone.

“Under a terms of a contract, Collegium is financially accountable if a normal daily sip strengths of Xtampza ER prescribed for Cigna business surpass a specific threshold,” Cigna stated. “If a threshold is exceeded, Collegium will revoke a cost of a remedy for many of Cigna’s advantage plans.”

Cigna believes that joining financial terms to sip metrics will assistance forestall overprescribing, Eldred explained.

“While drug companies don’t control prescriptions, they can assistance change studious and alloy conversations by educating people about their medications,” pronounced Maesner.

In a matter final week, Purdue Pharma, a manufacturer of OxyContin, pronounced that “Cigna’s preference boundary a collection prescribers can use to assistance residence a opioid predicament as both products are formulated with properties designed to deter abuse. Unfortunately, this preference appears to be some-more about curative rebates.”

A opposite approach

Dr. Andrew Kolodny, executive of opioid process investigate during a Heller School of Social Policy and Management during Brandeis University in Massachusetts, pronounced that Cigna’s proceed with Xtampza ER runs discordant to common attention practices.

“Typically, a aloft a dose, a some-more a association makes,” Kolodny told Healthline.

Kolodny has called for a U.S. Food and Drug Administration (FDA) to anathema all ultra-high-dose opioid drugs.

Kolodny pronounced that stealing doctors to allot revoke doses of oxycodone-based remedy “would be helpful” in shortening a risk of opioid dependence.

Dr. Michael Lowenstein, medical executive of a fast opioid-detoxification module called a Waismann Method, pronounced that Collegium could use enticements like “copay cards.”

These would be used to revoke or discharge a volume that patients have to compensate out of slot for Xtampza ER. This could inspire physicians to allot a lower-dose drug.

Experts indicate out that while authorised opioids like OxyContin and Xtampza ER can be a gateway to addiction, a reformulations done in new years make it reduction expected that they’ll be directly misused.

However, long-term users of these authorised pharmaceuticals can spin contingent on them. Some slip into serious obsession and spin to a unlawful marketplace for other opioid drugs, including heroin.

Part of a trend

Lowenstein told Healthline that Cigna’s new proceed to opioid-drug government is contemplative of a ubiquitous trend among pain government specialists to allot revoke doses of opioid drugs to patients.

When OxyContin initial came on a market, for example, it wasn’t odd to see patients get prescriptions for 80 mg of a drug to be taken 3 times daily, he said.

Now, a Centers for Disease Control and Prevention (CDC) generally recommends that a daily sip of opioids not surpass 90 hypnotic milligram equivalents (MME). This works out to about 60 mg of oxycodone sum in a day.

“You can’t get in as most difficulty with 20 milligram [pills] of oxycodone as we can with 80 milligram,” pronounced Lowenstein. “There’s reduction abuse potential.”

Stacey E. Grant, PharmD, executive of clinical deliberate services during axialHealthcare, commended Cigna for noticing “the fundamental risks of providing endless coverage for opioids” while “also holding stairs to quell a widespread confronting tens of millions of Americans.”

However, Grant told Healthline, “We trust that a intensity short-term disastrous consequences of stealing a remedy therapy from patients’ caring skeleton transcend a long-term advantages of mitigating opioid misuse.”

Addressing health insurers, Grant added: “While a remedy drug like OxyContin might lead to opioid use disorder, a best probable magnitude to take would be to cover some-more obsession diagnosis options while operative closely with physicians to forestall some-more patients from pang from or being during risk of opioid use disorder.”