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News from Attorney Carlos Gamino

Insurance Companies Refusing to Pay for OxyContin Prescriptions

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By Carlos Gamino

Cigna, Blue Cross Blue Shield of Florida, and now Blue Cross Blue Shield of Tennessee have officially dropped coverage of the highly addictive opioid OxyContin.

OxyContin’s manufacturer, Purdue Pharma, is facing dozens of lawsuits – not just over its contribution to the opioid epidemic in the U.S., but also because of the company’s high-pressure sales tactics.

"We felt it was time to move to those products and remove Oxycontin from the formulary, which does still continue to have a higher street value," says Natalie Tate, Blue Cross Blue Shield of Tennessee’s vice president of pharmacy. “We are not telling our physicians you cannot prescribe this. We are not telling our members you cannot receive this. 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.”

Purdue Pharma is accusing BCBS of having financial motives, rather than a genuine concern for patients.

"We believe that patients should have access to FDA-approved products with abuse-deterrent properties," Purdue's Robert Josephson wrote in an email. "The recent decision by Blue Cross Blue Shield of Tennessee limits prescribers' options to help address the opioid crisis."

Josephson appears to be referring to the fact that OxyContin was reformulated in 2010 to make it more difficult to crush or liquefy. However, it didn’t work well – and it also caused, according to The New England Journal of Medicine – unintended consequences.

The NEJM’s report says, “Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be in solving the growing problem of opioid abuse.”

What Do You Think?

Do you think Blue Cross Blue Shield and other insurers are right to stop covering opioids like OxyContin, or could this lead to bigger problems? Is it fair for insurance companies to step in like this?

I’d love to hear your opinion, so please share your thoughts on my Facebook page or on Twitter.

Carlos Gamino