Cigna's move to drop OxyContin coverage unlikely to curb opioid misuse
Cigna Corp. said it will stop covering prescriptions for opioid pain medication Oxycontin next year as part of its initiative to reduce opioid use among its members. But addiction experts said Cigna's decision will do little to reduce opioid use in a crisis that has left thousands dead.
Bloomfield, Conn.-based Cigna on Wednesday said it will no longer include OxyContin as a preferred prescription for its employer-based health plans starting Jan. 1, 2018. The insurer said it is contacting customers and their doctors so they have time to find alternative treatments. Cancer and hospice patients who are using will continue to be covered.
Instead, Cigna is replacing the drug with a clinically equivalent medication called Xtampza ER that it said has "abuse deterrent properties." The insurer said it has signed a value-based contract with Xtampza ER drugmaker Collegium Pharmaceutical, and Collegium will reduce the cost of the medication if its average daily dosage strengths exceed a specific threshold.
"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," Jon Maesner, Cigna's chief pharmacy officer, said in a statement. "We continually evaluate the clinical effectiveness, affordability and safety of all our covered medications as these characteristics can change over time, and we make adjustments that we believe will provide better overall value for those we serve."
Oxycontin manufacturer Purdue Pharma, however, said Cigna's decision "appears to be more about pharmaceutical rebates" than addressing the opioid epidemic. "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," the company said in a statement.
Addiction addicts are skeptical that Cigna's formulary change-up will do much to reduce opioid abuse.
"Do I think this is going to have a significant impact on overdose deaths? No I don't see how this step would do that," said Kent Runyon, vice president of community relations and compliance at Novus Medical Detox Center, an inpatient substance abuse detox facility in Pasco County, Fla.
There is little difference between OxyContin and Xtampza. Both are labeled as having abuse-deterrant properties. Even if a drug company has succeeded in convincing the FDA that its opioid medication has built-in deterrents for misuse, patients seem to find a way around those deterrents, Runyon said.
Still, even small steps aimed at addressing the opioid epidemic are good news. "My hope is that at least this starts a conversation between prescribers and their patients" around addiction and opioid dependence, he said.
Dr. Andrew Kolodny, co-director of policy research at Brandeis University, however, said there's promise in the value-based contract between Cigna and Collegium. The contract, which Kolodny said is unique in the market, creates financial incentive for the drugmaker to encourage doctors to prescribe low doses of the opioid medication over higher doses. High doses of opioids are known to pose a greater risk of addiction. Typically, drugmakers have incentive to promote higher doses of opioids because the cost per pill is higher, Kolodny said.
Cigna is betting that manufacturers and their drug representatives will be able to influence doctors' prescribing behavior, Kolodny explained, adding that the strategy is "smart." Studies have shown that pharmaceutical companies hold sway over prescribing practices. Moreover, one in 12 U.S. doctors accepted payments from opioid manufacturers from 2013 to 2015, according to one recent study.
Even so, it's unclear if Cigna's strategy will have a dramatic effect on opioid use, Kolodny said.
Cigna said its decision to remove Oxycontin from its coverage list is part of its goal to reduce opioid use among customers by 25% by 2019. To accomplish this, the insurer also builds opioid prescribing profiles of the physicians and accountable care organizations in its network. It sends that information to the doctors on a regular basis so they can see how they compare with their peers. The insurer also encourages its participating ACOs to pledge to fight the opioid epidemic. About 160 have signed the pledge so far.
In recent months, Cigna and other big insurers, including UnitedHealth, Aetna and Anthem, have also lifted prior authorization policies for medication-assisted treatment in response to growing pressure from the public, policymakers and law enforcement officials. MAT combines medication and behavioral health therapy to treat addiction, and experts say prior authorization policies have long been barriers to treatment access.
In April, Cigna said it's efforts were paying off as prescription opioid use among customers fell by almost 12% in the previous year.
Still, the opioid epidemic is worsening. Addiction experts say insurers aren't doing enough to make substance abuse treatment readily available. In 2015, opioids led to more than 33,000 overdose deaths, up more than 15% from 28,600 in 2014, according to the Centers for Disease Control and Prevention.
"We have a law in place that talks about parity between mental health care and medical healthcare. One thing would be to have insurers truly begin to act that way and, for those who are assessed to have a substance use disorder and who need treatment, to in fact provide appropriate levels of care to consumers who need treatment," Runyon said.
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