Insurers refuse to cover OxyContin
Industries clash over attempt to fight epidemic by dropping notorious opioid
Private insurers across the country and in Texas have entered the public fight against opioid addiction, with some now outright denying coverage of OxyContin, the most notorious of drugs linked to the crisis.
But the move has unleashed a clash of opinion over its wisdom, with the insurance industry defending the crackdown as an important deterrent while some in Houston’s drug abuse treatment and pain management communities call it an overreaction and question the effectiveness of taking a stand against one drug.
“This is a whack-a-mole solution,” said James Langabeer, professor of emergency medicine at McGovern Medical School at UTHealth who also leads the Houston Emergency Opioid Engagement System to help patients navigate treatment and recovery options.
“On the one hand, it’s good that the insurance industry is weighing in,” he said, “but I don’t believe we should be isolating one category of opioid versus another.”
The worry is that those already addicted will not be stopped if their drug of choice becomes harder to get. They may simply turn to another prescription opioid or a street drug, such as heroin, which can sometimes be cheaper and easier to get, Langabeer said.
OxyContin, manufactured by Purdue Pharma, is the brand name for oxycodone, a narcotic drug used to treat moderate to severe pain. The drugmaker has been at the heart of scandal and litigation in recent years amid allegations it intentionally misled doctors about the safety of ratcheting up doses. In May, Texas sued Purdue Pharma contending that deceptive marketing helped fuel the opioid crisis.
‘Drawing a line’
Last week, Blue Cross and Blue Shield of Tennessee, that state’s largest insurer, became the latest company to announce it will stop covering OxyContin prescriptions beginning Jan. 1, 2019. Officials with the company told the Tennessean they were “just drawing a line that we will not continue to pay for this.”
The announcement follows a nationwide halt by two national insurance giants, Cigna and UnitedHealthcare, which together have millions of Texas members.
Cigna grabbed headlines last fall when it announced it was dropping coverage of OxyContin from its list of preferred medications for employer-sponsored health plans beginning this year. About 1 million Texans have such plans, a Cigna spokesman said.
Cigna customers who are already taking the drug for hospice or cancer treatment will be covered through the end of 2018, the company said. After that, the insurer will “consider approving coverage for Oxycontin if a customer’s doctor feels that treatment with OxyContin is medically necessary,” a statement emailed to the Chronicle said.
UnitedHealthcare more quietly stopped covering OxyContin in its employer-sponsored plans on Jan. 1, 2017. More than 3 million Texans have those plans.
“There are therapeutically equivalent, covered alternatives that can be used for pain indications,” a spokesman for UnitedHealthcare said in an emailed statement on Monday.
Those include non-opioid prescriptions as well as other pain management treatments such as chiropractic services and physical therapy, the insurer said, although it was not clear what alternatives will be covered.
Florida Blue, the largest insurer in Florida, also stopped covering OxyContin for its group and individual plan members at the start of 2018.
Cigna and Florida Blue will replace Oxycontin as a preferred medication with Xtampza, an oxycondone substitute that is said to be harder to abuse. Blue Cross and Blue Shield of Tennessee will encourage doctors to prescribe Xtmapza or Morphabond, also an opioid. The insurers have said that doctors can continue to write prescriptions for the drug but it will not be routinely covered.
Purdue responds
Purdue Pharma has reacted strongly to the coverage ban, arguing that it has already taken steps to make its product harder to abuse by changing the formula. It also accused insurers of backing competitors for financial gain.
“These recent decisions by insurance companies limit prescribers’ options to help address the opioid crisis,” a company spokesman said in an emailed statement, adding that the alternative medications are no safer or more abuse-proof.
“Unfortunately, these decisions appear to be more about pharmaceutical rebates,” the statement said.
Rather than banning the drug outright, regional Texas insurers are taking a different approach.
Blue Cross and Blue Shield of Texas said Monday it will continue to cover OxyContin for its members, but the company has instituted a series of safeguards to spot and curtail potential overuse.
The company’s Appropriate Use of Opioids Program was launched Aug. 1 and will be phased in over eight months. Under the program, the state’s largest insurer will scrutinize quantity and dosage of prescriptions for opioids and check for different doctors writing similar prescriptions for one patient, the insurer said.
“The BCBSTX prescription drug list is routinely reviewed to determine which medications are safe, effective and affordable. Updates to the drug list — such as removing/adding drugs — are made based on these guidelines and other changes in the pharmaceutical market,” the insurer said in a statement.
Community Health Choice, a Houston-based health insurer, will also continue to cover OxyContin but will restrict the number of pills prescribed and will monitor multiple prescriptions to the same patient as well as track doctors who appear to be overprescribing, said Dr. Karen Hill, senior vice president of medical affairs for the insurance company
She is unsure how effective prohibiting one drug can be in the overall battle against the opioid crisis. “We think it’s narrow-sighted,” she said.
OxyContin has been a proven benefit to some patients, including those with cancer, at the end of their lives or post-surgery, she said.
Dr. Brian Bruel, associate professor of physical medicine and rehabilitation at Baylor College of Medicine, takes it a step further. “This, to me, is (insurers) practicing medicine,” he said.
By the numbers
Still, no one is disputing the horror of the numbers.
The United States is now seeing the highest drug overdose death rate ever recorded, according to officials at the Centers for Disease Control and Prevention. In 2016, there were 42,000 drug overdose deaths involving opioids. That’s 116 people dying per day.
And while Texas has not seen the opioid ravages of other states, it has been flagged as showing a “significant” increase in drug overdose deaths, climbing to 2,831 in 2016 from 2,588 deaths in 2015, according to the CDC.
Katharine Neill Harris, a fellow in Drug Policy at Rice University’s Baker Institute of Public Policy, has mixed feelings about insurers’ entrance into the fray. While, like others, she said she’s glad to see action, she wonders if it is late in coming and not the best path.
“They do have a role, and I don’t think they have done enough yet,” she said, but added: “The easiest way to say we’re doing something is by stopping covering a drug.”
While cautiously supportive of restricting opioids for new patients, she thinks doctors need to have the discretion to recommend pain medication they know is already working for established patients.
What Harris would really like to see is for both the insurance industry and doctors to be more open to exploring other remedies such as long-term physical therapy for chronic pain rather rather than grabbing a prescription pad.