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Cigna to no longer cover OxyContin

Insurer has entered a value-based contract with Collegium Pharmaceutical for the drug Xtampza ER, an oxycodone equivalent.

Susan Morse, Senior Editor

Cigna is removing OxyContin as a covered drug effective January 1.

The move is to reduce members' opioid use, Cigna said.

Cigna said it has signed a value-based contract with Collegium Pharmaceutical for the drug Xtampza ER, an oxycodone equivalent with abuse deterrent properties.

Under the terms of the contract, Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold. If this happens, Collegium will reduce the cost of the medication for many of Cigna's benefit plans.

Linking financial terms to dosage metrics may encourage more education to prevent overprescribing, Cigna said.

The contract is effective January 1, 2018 for Cigna's commercial business.

[Also: NCQA updates HEDIS measures to address opioids and telehealth]

Xtampza ER is currently a preferred brand for oxycodone on Cigna's group commercial drug lists and will remain so in 2018, the insurer said.

"While drug companies don't control prescriptions, they can help influence patient and doctor conversations by educating people about their medications," said Jon Maesner, Pharm D, Cigna's chief pharmacy officer. "The insights we obtain from the metrics in the new value-based contract will help us continue to evolve our opioid management strategies to assist our customers and their doctors."

Cigna has as a goal to reduce opioid use among its customers by 25 percent by 2019. Its covered drug lists are evaluated with an eye to eliminating the inappropriate use of opioids to help consumers achieve positive health results while managing out-of-pocket costs, the company said.

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

"As a result of this review, the brand OxyContin is no longer covered as a preferred option on Cigna's group commercial drug lists effective January 1, 2018," Cigna said.

Individuals who have started using OxyContin for hospice care or cancer treatments will continue to have the medication covered in 2018. As with other medications that are not on covered drug lists, Cigna said it would consider approving coverage for OxyContin if a customer's doctor feels that treatment using OxyContin is medically necessary.

Twitter: @SusanJMorse

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