BlueCross changes opioid coverage policies

Sept. 06--Updated at 6:44 p.m. on Thursday, Sept. 6, 2018, with more information.

Tennessee's largest health insurance provider is making big changes to its prescription opioid coverage next year, including new supply limits and eliminating coverage of OxyContin -- the drug at the center of hundreds of lawsuits nationwide concerning the opioid epidemic.

BlueCross BlueShield of Tennessee officials on Thursday announced the new policies that Natalie Tate, vice president of pharmacy, called the "next step for us to take to help combat inappropriate utilization of opioids our goal is appropriate use. It is not to have no use of opioids."

Many plans within the BlueCross system already place supply limits on patients who are new to opioid painkillers, but the insurer is going further by also restricting coverage based on prescription strength and duration. BlueCross also will offer an acupuncture therapy benefit for an alternative treatment option.

The changes apply to BlueCross BlueShield of Tennessee commercially insured members, including individuals with Affordable Care Act plans.

"In Tennessee, it's a little bit different than it is in other states, for example in the Northeast, where utilization is much lower," Tate said, "so we are taking measures we feel are most appropriate for our population."

Almost three-fourths of the state's 1,776 drug overdose deaths in 2017 were associated with opioids, a class of drugs that are addictive and can cause serious or fatal side effects, particularly when taken in high doses with other substances. Of those deaths, 644 were associated with prescription opioid painkillers, such as hydrocodone, oxycodone and morphine, according to data from the Tennessee Department of Health.

Providers can still write prescriptions they deem necessary, but starting Jan. 1, the insurer will only cover the first seven days of a new opioid prescription. Prescriptions for more than 120 milligrams of opioids per day or for more than 30 days' worth of short-acting medication within 90 days will need additional prior authorization in order to be covered.

BlueCross leaders consulted independent medical and public health experts to help develop the changes. However, they still anticipate some backlash from the community.

"Any time we put in restrictions we see noise," Tate said, "which is why we're talking about this earlier than sometimes we talk about changes. We want to make sure we educate on not only what we're doing, why we're doing it, and then what steps someone needs to take if they do need an authorization for extended use."

Opioid prescriptions for people undergoing cancer treatment, palliative or end-of-life care are exempt from the new policy.

"We recognize that those populations are sensitive and vulnerable, and as there are other populations that may come up over time, we'll certainly consider and look at those," she said.

In lieu of OxyContin, BlueCross will add two different opioids -- Xtampza and Morphabond -- as preferred brand medications. Tate said these drugs provide comparable pain relief but are harder to crush and abuse.

Although the new "abuse-deterrent drugs" are more expensive, BlueCross spokeswoman Mary Danielson said the company will absorb the extra cost, so current copayments stay the same, and generic oxycodone also will remain covered.

"The generic is lower cost and still provides the doctors an option when prescribing to their patients," Danielson said in an email. "There may be some cases where the docs feel it's the right course to prescribe an abuse deterrent and in others the generic."

And the generic does not carry the same street value as the branded OxyContin, Danielson said.

Not everyone will be affected by the changes, according to the Associated Press. 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, the AP reported.

Contact staff writer Elizabeth Fite at [email protected] or 423-757-6673.

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