Promoting Safer Use of Opioids

At Cigna, we aim to protect our clients and customers from unnecessary costs when clinically appropriate lower cost alternatives are available. Even more important than controlling cost, is managing drug safety.  Which is why we have an ongoing review to manage the use of dangerous narcotic medications (also called opioids).

Beginning July 1, 2017, we will use tighter drug management practices to promote safer use of opioids

Drug overdose is the leading cause of accidental death in the U.S., with opioid addiction driving this epidemic.¹ It’s for this reason that on July 1, 2017, we are putting prior authorizations and quantity limits in place for first time opioid users based on Centers for Disease Control and Prevention (CDC) guidelines. Implementing these changes to our drug management (also called utilization management) programs will make the use of opioids safer for our customers. Below are details to the drug management practices that may apply to your formulary.

Prior authorizations
Customer’s newly prescribed long-acting opioid may be subject to a prior authorization

• Newly prescribed:
• A long acting opioid is generally taken once/day and is affective throughout the day

Quantity limits
Customer’s newly prescribed short-acting opioid may be subject to quantity limits

• Newly prescribed:
• A short acting opioid is generally taken several times/day and is affective for a short (hourly) period of time
• Quantity limits will apply to prescriptions over a 15 day supply
• Additional drugs that will have quantity limits applied:
  • High dose prescriptions (per FDA drug safety dosing recommendations)
  • Cough agents with codeine (per FDA drug safety dosing recommendations)
• Note: We are leveraging our integrated capabilities to identify customers using opioids as part of treatment for cancer, sickle cell or are in hospice to assure those customers are not affected by these changes.

What you should know about those receiving a first time opioid prescription:

• Since there is no way to predict who may receive a first time opioid prescription, there will not be letters sent to affected customers.
  • Service team will be ready to assist customers, doctors and pharmacists
  • Prior authorizations reviews will be expedited within 24 hours so customers have a plan of action
  • Pharmacists will see message on computer to assist customer with asmaller quantity or to help through the Cigna’s authorization process for long-acting opioids
  • We will clearly communicate our opioid changes with network prescribers prior to 7/1/17 to elicit their cooperation
  • There is a letter clients can send to all employees – sent to clients upon request

Our priority is to maintain affordability and drug safety for our clients and customers.

1. Opioid addiction facts and figures – American Society of Addition Medicine 2016