Cigna to Stop Covering OxyContin Prescriptions


Health insurance company Cigna will stop covering most OxyContin prescriptions beginning January 1, 2018, the company announced Wednesday.

Jon Maesner, Cigna’s chief pharmacy officer, said in a statement Wednesday that Cigna’s focus is on “helping customers get the most value from their medications,” which means “obtaining effective pain relief while also guarding against opioid misuse.”

“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,” Maesner said.

Under the new regulations, patients who have started using OxyContin for hospice care or cancer treatments can continue to have the medication covered in 2018, and like other medications that are not covered, Cigna says it will consider approving coverage if a patient’s doctor feels OxyContin is medically necessary.

OxyContin is a brand of extended-release oxycodone, a type of opioid pain reliever. Last year, Cigna announced it was committed to lowering its customers’ opioid use by 25 percent within three years.

In its statement, Cigna also revealed it had signed a “value-based contract” with Collegium Pharmaceutical for the drug Xtampza ER, an oxycodone equivalent with “abuse deterrent properties” (it allegedly maintains its extended release profile even when cut, crushed, chewed or manipulated). The contract states that Collegium will reduce the cost of the medication for Cigna benefit plans if the average daily dosage strength prescribed for the drug exceeds a specific threshold. The idea is that linking drug cost to dosage metrics may encourage more education to prevent overprescribing.

Cigna’s decision comes on the heels of CVS Pharmacy’s announcement that it would begin limiting opioid prescriptions to a seven-day supply for certain conditions in February 2018.

OxyContin is one of the prescription opioids commonly blamed for causing the opioid epidemic. But it’s important to remember that according to research, only between 8 and 12 percent of people using opioids develop an addiction, and 75 percent of opioid misuse begins with people using medication that wasn’t prescribed to them. Policies like Cigna’s lead many chronic pain patients who are using their medication responsibly to worry that it will become even harder for them to manage their pain.

“The media has unfortunately been leaving a huge portion of opioid users out of the picture. It’s these people who need to start having a voice in this conversation,” Heather Eichwald previously wrote on The Mighty.


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