Insurance Giant Cigna to Halt Coverage for Oxycontin

Cigna health insurance, the fourth largest insurer in the US company with over 11,400,000 members, has taken what is seen as a drastic step in the fight against opioid addiction. Effective in January, the insurance giant will effectively stop covering the cost of use of the opioid OxyContin.

While many in the addiction treatment profession have lauded this change, it’s important to look more carefully at what’s really going on. At the same time that Cigna announced they would no longer be providing coverage for Oxycontin, the company also announced a contract to continue covering a competing oxycodone alternative by the name of Xtampza ER. The contract includes a financial penalty on that drug’s maker if Cigna discovers the drug is overprescribed or there are other patterns indicating the drug has become a drug of abuse. Because of this stipulation, the manufacturer also has more motivation to monitor sales and look for areas of abuse and high prescription rates.

Cigna’s announcement comes just a year after the insurer said it intended to cut opioid use among its customers by 25% by 2019. Out of 33,000 opioid-related deaths in 2015, nearly half are attributed to Oxycontin or similar formularies, according to the CDC. (The remaining are attributed to heroin or to fentanyl, a synthetic opioid)

OxyContin is the only opioid-based prescription painkiller that Cigna is removing in 2018 from its formulary. (A formulary is the list of medications that an insurer will cover for its members.) Cigna will review individual prescriptions for OxyContin on a case-by-case basis, but people with terminal diseases will be able to continue taking it.

Will Cigna’s Actions Reduce Opiate Abuse?

So while this announcement sounds like a big move in taking drugs off the market, it appears to be more of a punishment for the manufacturers. A spokesman for Purdue Pharma, the Connecticut company that makes OxyContin, says that the drugs are pretty much the same in makeup, although Jon Maesner, Cigna’s chief pharmacy officer, insists that the insurer is “not specifically singling out Oxycontin.”

However, it appears trust is a central issue. “We found a strong sense of commitment” to reducing opioid overuse from Collegium Pharmaceuticals, the maker of the oxycodone drug that Cigna plans to cover instead. Purdue Pharma is currently facing dozens of lawsuits from cities, counties, and states across the US, all of them alleging that the drug makers cared more about profits and misled users and doctors about their addictive nature.

The contract with a new manufacturer helps create a relationship that makes drug makers more accountable to others involved in pain medicine. This is a great beginning for insurers who want to protect their patients.

However, there are literally dozens of other opioid and opiate drugs on the market, and many of them have yet to answer for their own part in creating the addiction epidemic. Until all of the “shady” pharma companies are held to account, there will be more pills mills and rampant addiction waiting in the shadows of this under-regulated industry.


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