Cigna Changes Opioid Coverage Policy; Announcement Raises Questions

Here's something you might not have seen: Cigna has changed its formulary and processes for short- and long-acting opioids to focus primarily on new prescriptions.

The insurance company claims it announced the change, which took effect July, in letters to physicians and providers and enrollees in March and June.

The changes are part of a "coordinated, comprehensive response" to the growing opioid-use crisis in the United States, Cigna said in a letter dated June 2.

"These change are based on the Centers for Disease Control and Prevention (CDC) opioid recommendations," the letter says. "The intent is to promote the use of alternative treatment options, when clinically appropriate, to minimize first-time exposures to these highly addictive drugs. Specifically: 

  • Prior authorization of coverage will be applied to prescription claims for customers new to therapy on long-acting opioids. With the potential for dependence, these changes help ensure dose, duration, and intent of the prescription are clinically appropriate.
  • Quantity limits will be applied to prescription claims for customers new to therapy on short acting opioids.
  • Additional drugs that will have quantity limits applied are: 
    • High dose prescriptions (per FDA [U.S. Food and Drug Administration] drug safety dosing recommendations)
    • Cough agents with codeine (per FDA drug safety dosing recommendations)."  

Some customers will be excluded from the changes, including patients with cancer, sickle cell disease, and those in hospice, Cigna said. 

If you wish to read Cigna’s full opioid therapy policy, you can find it on Cigna's website

Now, it's no surprise that a health plan is implementing such changes in light of the current opioid-use crisis. But a few aspects of the announcement beg some questions, including concerns that a "focus primarily on new prescriptions" could indicate that established prescriptions would also require prior authorization. The lack of a timely notification is also concerning. 

Check future editions of Action for updates.

Action, Aug. 1, 2017

Last Updated On

August 01, 2017

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