Biotech and Pharma

Cigna won't cover OxyContin prescriptions for 2018, as health insurer targets opioid abuse

Key Points
  • Big insurer Cigna said it will not cover the opioid OxyContin for customers who are insured through a job, starting in 2018.
  • Cigna last year said it wanted to cut opioid use by 25 percent among its customers by 2019.
  • More than half of the over 33,000 opioid-related deaths in 2015 were linked to prescription medications.
Cigna won't cover OxyContin prescriptions for 2018
Cigna won't cover OxyContin prescriptions for 2018

Major insurer Cigna — which is engaged in an effort to reduce abuse of prescription painkillers — announced Wednesday that it will effectively stop covering the cost of use of the opioid OxyContin by customers of its employer-based health plans beginning in January.

At the same time, Cigna announced a contract to continue covering a competing oxycodone alternative to OxyContin, which will impose a financial penalty on that drug's maker if too much of the drug ends up being used by the insurer's customers.

Oxycodone is used to treat moderate to severe pain.

Cigna's moves come more than a year after the insurer said it intended to cut opioid use among its customers by 25 percent by 2019.

The announcement also comes two months after President Donald Trump said the opioid-abuse crisis is a "national emergency."

There were more than 33,000 opioid-related deaths in 2015, the highest tally on record, according to the federal Centers for Disease Control and Prevention.

More than half of those deaths were linked to prescription opioids such as OxyContin. The rest were related to heroin or to fentanyl, a synthetic opioid.

"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," said Jon Maesner, Cigna's chief pharmacy officer on Wednesday.

OxyContin is the only opioid-based prescription painkiller that Cigna is removing in 2018 as "a preferred option" from its formulary, or list of medications that its health plans will pay for.

While Maesner said that Cigna would review individual prescriptions for OxyContin that are deemed "medically necessary" by a physician, the drug essentially is "being removed" from coverage by the insurer.

Cigna said that people who have already started using OxyContin for hospice care or cancer treatments will continue to have that medication covered next year.

Cigna said it has begun notifying customers who currently have OxyContin prescriptions, as well as their doctors, of the decision to stop covering the opioid "so that they have time to discuss treatment options and covered oxycodone clinical alternatives.

Maesner, who would not identify how many Cigna customers currently use OxyContin, said the insurer is "not specifically singling out Oxycontin."

But, he added, "we found a strong sense of commitment" to reducing opioid overuse from Collegium Pharmaceuticals, the maker of the oxycodone alternative that Cigna will continue to cover.

However, a spokesman for Purdue Pharma, the privately held Connecticut company that makes OxyContin, suggested there is little, if any, difference in between the two opioids in how they affect patients.

The spokesman, Robert Josephson, said OxyContin and Xtampza ER, the opioid that Cigna is continuing to cover, are both long-acting oxycodones.

Josephson also noted that both OxyContin and Xtampa ER are formulated in a way to deter abuse.

"We believe that patients should have access to FDA [Food and Drug Administration]-approved products with abuse deterrent properties," Josephson 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."

Xtampza ER is made by Collegium Pharmaceutical.

Cigna said that under the terms of the contract the insurer signed with Collegium that kicks in Jan. 1, "Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold."

"If the threshold is exceeded, Collegium will reduce the cost of the medication for many of Cigna's benefit plans," Cigna said.

Purdue Pharma has been sued by a number of states and cities in the past year for alleged deceptive marketing of its opioids.

"I don't know how executives at Purdue sleep at night," State of Washington Attorney General Bob Ferguson said last week as he announced one of those lawsuits accusing the drugmaker of downplaying the addictiveness OxyContin.

Purdue Pharma, which has declined the suits' claims, has noted that its products account for only 2 percent of all opioid prescriptions.

In 2007, the company and three Purdue Pharma executives pleaded guilty to federal criminal charges related to misbranding of OxyContin. Purdue Pharma agreed to pay $600 million in fines and other payments, while the executives agreed to pay $34.5 million in fines.

Cigna in 2016 announced a goal of slashing use of opioids among its customers by 25 percent over the next three years. Cigna said that as part of that initiative it would encourage doctors to prescribe the drugs in lesser quantities and for lesser amounts of time.

Last April, the insurer said opioid use among Cigna customers had already declined by 12 percent.

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New Hampshire sues OxyContin maker Purdue Pharma
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