Cigna on Wednesday announced it will stop covering Purdue Pharma's OxyContin as a preferred option for customers enrolled in employer-based health plans—but some industry experts say the move is unlikely to have a significant effect on the opioid misuse epidemic.
Cigna framed the move as a step toward its goal of reducing opioid use among its customers by 25 percent by 2019.
Details on the coverage change
Cigna said that rather than covering OxyContin, it will offer customers an oxycodone equivalent formulated with misuse-deterrent properties called Xtampza ER. According to Cigna, Xtampza ER's misuse-deterrent properties allow the drug "to maintain its extended release profile even when cut, crushed, chewed, or otherwise manipulated." Cigna will provide the treatment to customers under a value-based contract with Collegium Pharmaceutical, the drugmaker behind Xtampza ER.
Under the terms of contract—which takes effect Jan. 1, 2018—Collegium Pharmaceutical is "financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold." If the dosage exceeds the threshold, Collegium will lower the cost of Xtampza ER for many of Cigna's benefit plans. Cigna said that tying "financial terms to dosage metrics may encourage more education to prevent overprescribing."
Cigna said it "is in the process of notifying customers with current OxyContin prescriptions and their doctors of the upcoming change" in order to give them "time to discuss treatment options and covered oxycodone clinical alternatives." Cigna said it will continue to cover OxyContin for customers who have already started taking the drug for hospice care or cancer.
Jon Maesner, Cigna's chief pharmacy officer, said the company's "focus is on helping customers get the most value from their medications—this means obtaining effective pain relief while also guarding against opioid misuse." Maesner said Cigna "continually evaluate[s] the clinical effectiveness, affordability and safety of all [its] covered medications as these characteristics can change over time."
Industry experts say the move may have limited effects
Kent Runyon, vice president of community relations and compliance at Novus Medical Detox Center in Florida, said, "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." Runyon said that patients typically find a way around misuse deterrents built into medications. That said, Runyon said the move "starts a conversation between prescribers and their patients" around opioid misuse.
Wallid Gellad, co-director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, similarly said he expects that Cigna's move will have only a minor effect on opioid misuse. He said that Xtampza ER "is the same thing—it's a long-acting version of oxycodone. Whether there are subtle differences, I don't know, none that I'm aware of." Gellad added, "It looks like part of the reason is they signed a deal with the maker of this other product (to cover some costs) if the dose is higher than a certain amount."
Robert Josephson, Purdue's executive director for communications, denounced the move, saying, "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" (Mangan, CNBC, 10/4; Facher, STAT News, 10/4; Beasley, Reuters, 10/4; Livingston, Modern Healthcare, 10/5; Cigna release, 10/4).
Reduce opioid misuse and abuse with our new report
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.