BlueCross of Tennessee will stop covering OxyContin in 2019
Tennessee's largest health insurer will stop covering OxyContin prescriptions as part of several measures to combat opioid addiction.
BlueCross BlueShield of Tennessee will encourage doctors to recommend two alternative opioid pain relievers, Xtampza and Morphabond, which are designed to be more difficult to abuse. The insurer will cease paying for OxyContin on Jan. 1, vice president for pharmacy Natalie Tate told The Tennessean.
The suggested alternatives are more expensive than OxyContin, but customers will not have to fork over more money for the copay. Tate said BlueCross will absorb the additional cost.
"We are not telling our physicians you cannot prescribe this. We are not telling our members you cannot receive this," Tate said. "We are just drawing a line that we will not continue to pay for this and we have alternatives we have now put into place."
BlueCross covers around 70 percent of insured Tennesseans. It's not the first to drop OxyContin, but it's among a select few that includes Cigna and Florida Blue. Cancer and hospice patients with approved prescriptions will be exempt from this coverage change.
OxyContin is oxycodone manufactured by Purdue Pharma, a company accused of intentionally fueling the opioid epidemic. State and local governments across the country have filed lawsuits against Purdue Pharma, asserting that the manufacturer pressured doctors to over-prescribe the drug.
The lawsuits and health concerns have decreased demand for OxyContin, which, coupled with increased confidence in abuse-deterrent drugs led to BlueCross of Tennessee's "progressive decision," Tate said.
The opioid overdose epidemic claimed more than 1,200 lives in Tennessee last year. At its core is OxyContin, which can be ground into a powder to destroy its delayed-release quality, therefore unlocking its full potency and making it ripe for abuse. But Xtampza and Morphabond are designed to be less potent when crushed, making the medications hard to abuse or resell.
Like OxyContin, Xtampza is oxycodone, manufactured by Collegium Pharmaceutical. Morphabond is morphine sulfate manufactured by Daiichi Sankyo Inc.
The beginning of next year will bring additional changes to BlueCross of Tennessee's opioid prescription coverage.
The insurer will only cover the first seven days of a new opioid prescription on an initial pharmacy visit. Customers will have to return to the pharmacy after a week to receive the rest of the prescription. It will also lower the threshold for the prescription strength it's willing to cover by around 40 percent.
But the company predicts that the change that will most affect customers is a new requirement regarding opioid prescriptions that last more than 30 days. It will automatically freeze coverage after 30 days, requiring patients to undergo an authorization process before resuming coverage.
BlueCross of Tennessee Chief Medical Officer Allison Willis said she anticipates blowback by patients who feel inconvenienced or scrutinized.
"Really, what this is meant to do is ask a question - Is this necessary? - and I think that hasn't been asked for a lot of people," Willis said. "I do think some people will respond with 'how dare you even ask?'"
Not everyone will be affected by the changes. Employee groups with "self-funded" insurance will be allowed to opt out of the coverage changes. The new prescription-strength limit will not apply to Medicare customers, as the federal government decides the threshold. And the change will not apply to Tennesseans who are insured by an out-of-state chapter.