BlueCross of Tennessee will stop covering OxyContin in 2019


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MEMPHIS, Tenn. — Tennessee’s largest health insurer will stop covering OxyContin prescriptions as part of an effort to combat opioid addiction.

Last year, 1,268 people died in Tennessee from drug overdoses related to opioids. Ten percent of them lived in Shelby County.

“If we don’t take some drastic actions, it’s not going to stop. It’s going to keep getting worse," said Dr. Theodore Bender, chief executive officer at Turning Point.  “OxyContin abuse is at the epicenter of this entire epidemic.”

BlueCross BlueShield of Tennessee says the company will encourage doctors to recommend two alternatives to OxyContin, which BlueCross will cease paying for on Jan. 1.

The suggested alternatives, Xtampza and Morphabond, are more expensive opioid pain relievers and are less likely to be abused. Officials say customers will pay the same copay as for OxyContin, and BlueCross will absorb the additional cost.

“Those drugs are designed to be less potent when crushed," said Dr. Bender.

It's a method that can spiral into people using heroin and needles.

“A lot of them will say, ‘I’ll never use needles. I’ll never use needles.’ Everyone who is using needles has told me they’ve said that at one point," said Dr. Bender.

He says it’s important for patients to talk to their prescribers and doctors about other pain management options, but does believe this is a step in the right direction.

“The concern I have always with something like this is that we’re taking this situation and allowing insurance companies to make decisions that doctors should be making," said Dr. Bender.

In a statement, BlueCross said in part:

"The company hopes these changes will build on the success of its previous clinical and social efforts to reduce the supply of opioids. Positive changes from 2015 to 2018 have included 19 million fewer pills dispensed and a 26 percent decrease in opioid prescription claims, along with a drop in the strength of the opioids being used." 

“We are fully aware that many of our members face the reality of chronic pain, and many more may have situations arising from injury or surgery where pain medication – including opioids – may be part of a legitimate and necessary treatment plan,” said Dr. Natalie Tate, vice president of pharmacy for BlueCross. “We do not want to be disruptive or cause undue hardship, which is why we’ve taken this moderate and measured approach to changes in our coverage.”

Beginning Jan. 1, these BlueCross commercial coverage changes in Tennessee include:

  • A seven-day quantity limit for short-acting opioid prescriptions issued to members who are receiving the drug for the first time.
  • An enhanced prior authorization requirement for extended use of short-acting opioids. Specifically, this will impact those who use more than 30 days’ worth of short-acting medication in a 90-day period.
  • A lower threshold for morphine milligram equivalent dose (MME), with authorization required for more than 120 milligrams of opioids per day.
  • Removal of OxyContin from the list of covered drugs, to be replaced with drugs less likely to be abused.
  • Drug combination safety alerts for clinical teams and providers, which highlight inappropriate or dangerous drug combinations in order to promote appropriate use.
  • Addition of a benefit for alternative pain therapy.

OxyContin is manufactured by Purdue Pharma, which has been accused of intentionally fueling the opioid epidemic. Other large insurers, such as Cigna and Florida Blue, have made similar moves. This change affects only Tennessee, and Medicare customers and approved cancer and hospice patients are exempt.

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