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Cigna to implement prior authorization policy for opioid prescriptions

Use of prescribed opioids down close to 12 percent over 12 months among Cigna customers.

Susan Morse, Senior Editor

Starting July 1, Cigna will require prior authorization for physicians prescribing a long-acting opioid that is not being used as part of treatment for cancer or sickle cell disease, or for hospice care, the insurer said.

Also, most new prescriptions for a short-acting opioid will be subject to quantity limits, Cigna said.

[Also: Prior authorization needs streamlining, new healthcare coalition including AMA, MGMA says]

In releasing its new safety measures, Cigna is following Centers for Disease Control and Prevention guidelines issued last year that recommend non-opioid therapy as the preferable treatment for chronic pain outside of cancer treatment, palliative and end-of-life care.

Cigna's policy is in support of its goal to reduce customer use of prescribed opioids by 25 percent by 2019.  The insurer is halfway to its goal, Cigna announced last week in reporting a 12 percent decline last year.

[Also: Cigna to cut customer use of opioids by 25 percent over 3 years]

Nearly 62,000 doctors within 158 medical groups that are part of  Cigna collaborative care agreements have signed a pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition. 

Cigna is working with doctors and providers by analyzing integrated claims data across pharmacy and medical benefits to detect opioid use patterns that suggest possible misuse by individuals.

The insurer alerts doctors when their opioid prescribing patterns are not consistent with CDC guidelines.

It established a database of opioid quality improvement initiatives for physicians to help them determine the next steps for improving patient care, including referrals into chronic pain management or substance use disorder treatment programs.

[Also: Opioid prescription patterns vary within emergency rooms, study shows]

According to the CDC, drug overdoses are the leading cause of accidental death in the United States. Of the overdose deaths that occurred in 2015, 63 percent involved an opioid.

Providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills, according to the CDC said. Each day, 46 people die from an overdose of prescription painkillers in this country, the CDC said.

"As a country, we have developed an over-reliance on opioids to manage pain. If we're going to break the opioid epidemic, we need to change that culture," said Cigna President and CEO David Cordani. "Helping doctors become more aware of their own prescribing patterns and the effectiveness of non-narcotic alternatives for pain management is key to helping our customers have better health outcomes."

Cigna said it continues to work with Shatterproof, a national nonprofit organization that helps families living with substance use disorder. A Cigna Foundation grant helped the organization launch an online portal  earlier this year.

Twitter: @SusanJMorse

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