Florida insurance companies drop coverage of OxyContin 

FORT MYERS, Fla. — OxyContin has become one of the most recognizable brand names in the nation’s deadly opioid epidemic. Starting Jan. 1, the state’s largest health insurer will cease coverage of the drug in favor of a painkiller less easy to abuse.

Florida Blue’s alternate, Xtampza ER, is similar to OxyContin in that it is an extended-release, oxycodone-based product. 

The big difference, the company said Tuesday, is that Xtampza is more chemically suited to prevent users from crushing, snorting or injecting it — all means of getting a quicker, and potentially more lethal, high.

Florida Blue’s new policy will not apply to generic oxycodone, which is sold as an immediate-release drug at lower doses and is less likely to be so abused, said Scott McClelland, the company’s vice president of commercial and specialty pharmacy.

Florida Blue is taking the action because the abundance of opioids prescribed to its more than 5 million members represents a risk for abuse and provides evidence that doctors are doling out more than patients need of the powerful but addictive drug, said Scott McClelland, vice president of commercial and specialty pharmacy.

Opioids were the direct cause of 2,664 Florida overdose deaths in 2016 and showed up in the toxicology reports of 4,515 Floridians that year, according to an interim reportfrom the Florida Medical Examiners Commission.

“Imagine if you could take an 80-milligram extended-release (OxyContin) tablet and crush it and inject it and get it all at once, as opposed to a five-milligram oxycodone tablet,” McClelland said. “So, that’s the big reason there’s such huge concerns about these extended-release formulations. It’s a really big dose.”

The OxyContin ban applies to all Florida Blue individual and group plans. Medicare Advantage plans are excluded.

Xtampza ER is manufactured by Canton, Mass.-based Collegium Pharmaceutical Inc. Though it touts the drug’s “abuse-deterrent technology” it does not guarantee that the drug cannot be abused.

The company also notes: “Although Xtampza ER is formulated to make manipulation more difficult, it cannot entirely prevent abuse; abuse of Xtampza ER by injection and via the oral and nasal routes is still possible.”

The company’s decision to drop OxyContin follows a federal declaration earlier this year that the nation is in the grips of an opioid overdose epidemic. Shortly thereafter, Florida Gov. Rick Scott signed an executive order declaring the opioid epidemic a statewide public health emergency.

Fentanyl, morphine, and heroin were the top three causes of lethal opioid overdoses. Oxycodone was fourth.
Florida Blue typically pays for 1.5 million opioid prescriptions every year, according to the company. About 8% of that business is for prescriptions lasting longer than 30 days, a group at a higher risk for addiction and overdose.

Florida Blue already has quantity limits on long- and short-acting painkillers. It has also required prior approval for prescriptions of extended-release opioid painkillers, such as OxyContin and fentanyl.

The policy was updated Oct. 1 to include prior approval for short-acting painkillers needed for more than seven days, McClelland said.

“We want to prevent as much abuse and addiction and deaths related to these overdoses as possible,” he said. “We’re just trying to take an active role and prevent these deaths that are occurring on a daily basis.”

Cigna also announced it will continue covering the same OxyContin alternative,Xtampza ER, as   part of its efforts to cut opioid use by its customers 25% by 2019, CNBC reported.

“Our focus is on helping customers get the most value from their medications — this means obtaining effective pain relief while also guarding against opioid misuse,” Cigna Chief Pharmacy Officer Jon Maesner said in a statement Wednesday.

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