Florida Blue will not cover painkiller OxyContin

To help fight the opioid epidemic, Florida Blue has decided to stop covering the prescription painkiller OxyContin starting next year and is replacing it with a newer drug called Xtampza ER, which is difficult to crush and abuse.

“We’ve been looking at the use of opiates in our membership for a number of years,” said Scott McClelland, vice president of commercial and specialty pharmacy at Florida Blue. “When Xtampza ER came along, we reviewed it … and we thought it would be safer for our membership.”

The two are different brand names for oxycodone, an opioid medication that’s used to treat moderate to severe pain, but it’s also been one of the most abused prescription drugs in the current epidemic.

Over time, drug manufacturers have made modifications to the pills to make them more difficult to crush or melt. Xtampza ER has its own unique abuse-detterrent technology.

“Xtampza ER has a wax matrix structure, so the only way to get it to liquid format is by melting at 170 degrees,” said Rick Foley, a pharmacist in Orlando. “You could inject molten wax, but it would be once, because it’ll solidify [in the vein].”

But critics say the switch isn’t the answer to the opioid epidemic that’s ravaging the state.

“My feeling is that it’s not going to do anything for this crisis,” said Dr. Chris Johnson, an emergency physician in Minnesota and a member of Physicians for Responsible Opioid Prescribing. “Nothing about this policy changes the fact that they’re going to prescribe extended release opioids for patients … and that’s still going to cause opioid dependence. It’s just giving the mere appearance that they care.”

But McClelland maintained the switch is a step toward curbing opioid abuse.

“Covering anything and not giving the doctors a new tool to prevent abuse is a bad thing,” said McClelland. “We’re sort of helping physicians.”

He said that because of Xtampza ER’s formulation, if the drugs falls into the hands of a curious child who chews the drug, it won’t instantly break down to a large dose of oxycodone and will maintain its extended release property.

“So we may have saved a life with this,” he said.

The change doesn’t affect Florida Blue members with Medicare Advantage.

But starting Jan. 1, other members with commercial plans won’t be able to use their insurance coverage to get OxyContin.

They can, however, pay the full price out of pocket if they choose. Otherwise, the pharmacist will contact the doctor’s office to replace the prescription with either Xtampza ER or another pain medication.

There may be other reasons — financial, more specifically — for the company to make this decision, speculated Dr. Edward Michna, who sits on the board of directors for the American Pain Society.

“Pharmaceutical companies have been giving rebates to insurance companies to have preferential standing,” said Michna.

“The bottom line is to save the [insurance] plan money and to build a formulary with proven, effective drugs, but with those that cost the plan less. And it doesn’t hurt if they can get some free good will.”