Health Care

To fight opioid crisis, Florida’s largest insurer stops covering OxyContin

That leftover bottle of painkillers in your medicine cabinet is one of the reasons that Florida’s largest health insurance company will stop covering OxyContin, the brand name prescription opioid, beginning Jan. 1.

Instead, the insurer will start covering an alternative opioid that isn’t crushable for injection or snorting, reducing its potential for abuse, the company said Monday.

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.

With federal officials declaring a national opioid overdose epidemic, and Florida Gov. Rick Scott pronouncing a statewide public health emergency due to widespread abuse of opioids, McClelland said Florida Blue wants to try a new approach to addressing the crisis.

“Most physicians, most plans have had a hands-off approach for a number of years, and we see where we are now,” McClelland said. “We think it’s time for more people, including physicians in our community, the nurses, even the families to take a more proactive approach in trying to manage this epidemic.”

OxyContin is the brand-name version of oxycodone, a narcotic drug used to treat moderate to severe long-term pain. Under the new policy, Florida Blue will drop coverage of OxyContin for all group and individual health insurance plans, except Medicare Advantage plans.

Instead of OxyContin, Florida Blue will cover a similar opioid called Xtampza ER, which is also made from oxycodone. But Xtampza ER is designed to deter abuse because the pills cannot be crushed for injecting or snorting.

“It makes the street value a lot less because it’s harder to manipulate,” McClelland said.

While Florida Blue will cover Xtampza ER, the insurer will stick to a policy it enacted in 2015 that requires prior authorization for all oxycodone prescriptions of more than seven days.

“We’re just trying to make sure there’s a process in place by which physicians think about how many pills they’re prescribing and the length that someone should get,” McClelland said. “When we put this in place [in 2015], we started hearing from a number of people saying, ‘Oh yeah, I went to my dentist and they gave me like 60 oxycodone, but I only needed five tablets.’”

The unused drugs often end up on the street, McClelland said.

Florida Blue’s 2015 policy change led to a 20 percent reduction in the use of long-term opioids by members over 12 months, McClelland said.

Florida Blue approves about 1.5 million opioid prescriptions each year. On average, about 8 percent of the insurer’s members use opioids for longer than 30 days.

Opioids were the direct cause of death of 2,538 Floridians and contributed to an additional 1,358 deaths in 2015, the last year data is available.

Other insurers have latched on to Xtampza ER as an alternative to OxyContin.

In October, Cigna also said it will stop covering OxyContin and cover Xtampza instead.

Purdue Pharma, the manufacturer of OxyContin, supports limiting the supply of its branded drug, according the company’s public policies. But a spokeswoman for the pharmaceutical manufacturer said Florida Blue’s new policy will make it more difficult for doctors to address addiction in their patients and noted that Xtampza ER still has potential for abuse.

“Florida Blue’s decision limits prescribers’ options to help address the opioid crisis,” Danielle Lewis, a Purdue Pharma spokeswoman, said in an email. “Further, while both products are formulated with properties designed to deter intranasal [snorting] and intravenous [injection] abuse, neither is abuse proof.”

Daniel Chang: 305-376-2012, @dchangmiami