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PITTSBURGH (KDKA) – OxyContin — it’s a popularly prescribed pain-killer.
But effective Jan. 1, insurance giant Cigna says it will no longer cover most OxyContin prescriptions.
“Cigna is one of the largest networks in the country, so it carries with it a lot of weight,” says pharmacist Adam Rice, who owns Spartan Pharmacy.
Cigna says it wants to help reduce opioid use and, therefore, abuse among its customers.
In a statement, Dr. Jon Maesner, chief pharmacy officer, said, “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.”
OxyContin is now covered by Cigna and other insurance companies.
But when Cigna stops covering it, it will cost Cigna’s customers over $1,000 for 100 pills.
Rice says the good news is there are alternatives.
“There’s plenty of alternatives. There’s nothing unique with OxyContin,” he said. “It’s the same pain medicine that’s in Percocet and any number of other opioid therapies.”
Cigna is pushing an alternative painkiller called xTampzaER over OxyContin. Dr. Walid Gellad, co-director of the University of Pittsburgh’s Center for Pharmaceutical Policy & Prescribing thinks he knows why.
“This may be less around addressing the opioid epidemic and more around a financial deal which it seems like Cigna has struck with this other manufacturer,” Gellad told KDKA money editor Jon Delano on Friday.
“The pharmaceutical industry is one of the largest industries in the country. Everything comes with a price,” adds Rice.
The Cigna announcement comes as the retail chain CVS said it will limit opioid prescriptions to just seven days, no matter what the doctor prescribes.
“I believe it’s just a bit of posturing. I think a bit of self-righteousness is supplanting customer service here,” says Rice.
Rice says, as long as it’s legal, Spartan Pharmacy will follow the doctor’s order.
CVS Limits Opioid Prescriptions To Seven Days —
So is it likely that other companies will follow both Cigna and CVS?
“Pittsburgh really isn’t a market that’s a huge Cigna market. We’re dominated by Highmark and UPMC, as everyone is familiar with, but we do have, especially in the Medicare Part D, a number of Cigna customers,” notes Rice.
Experts say insurance companies are dictating medical prescriptions.
“Insurance companies will say you can’t order this drug or that drug. It’s becoming increasingly common,” says Gellad.
Gellad thinks more insurers will follow Cigna’s example with a consequence to patients.
“It does limit the ability of the doctors to decide what drug someone should be on or at least it makes it more difficult for those doctors to do so because you have to jump through hoops,” Gellad said. “And in some cases that can be good, and in some cases that can be bad. The key issue is the motivation the right one — what’s best for the patient — or is the motivation the wrong one — which is what’s best for our bottom line.”
As for the CVS policy, no word from Rite-Aid, Walgreen’s, or other retail drug chains, if they will follow suit.
What is clear is that the crisis is such that the government could very well step in.
“The current administration in Washington is looking into this finally. I think the writing is on the wall,” says Rice.