Pharm D Corner

Insights from doctors of pharmacy.

Knocking down walls: Cigna ends preauthorization for opioid addiction treatment

Mimi Chen, PharmD

You’ve all seen the headlines and statistics:

“Drug overdose deaths have now surpassed fatal car accidents, with more than 47,00 lethal overdoses in 2014.”

“In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of narcotics.”

“Deaths from prescription painkillers and heroin have quadrupled since 1999.”

We have had enough. The truth is that there are simply too many too manys—too many deaths, too many ruined lives, and too many devastated families—affected by just one class of painkillers. It is prevalent enough that you probably know someone or a family member of a person who is addicted to narcotics.

Health care professionals and policy makers are scrambling to combat the opioid epidemic and to question many barriers to opioid addiction treatment that are coming under scrutiny only as the epidemic has worsened.

Cigna recently took down one of these barriers. An investigation by New York State Attorney General Eric Schneiderman revealed that Cigna’s prior authorization (PA) procedures for obtaining medication assisted treatment (MAT) with buprenorphine required doctors to provide extensive patient information. The process could delay the initiation of treatment by several days and affect the chances of it succeding.

In a national settlement with Mr. Schneiderman, Cigna agreed to end the PA prerequisite for MAT starting in mid-October. Clinical evidence suggests that utilizing MAT long term is more effective than acute detoxification programs. Enhancing patient access to these treatments is vital to tackling the opioid problem. Cigna has been applauded in its efforts, and public officials are urging payers to follow its lead. Quietly, however, many have already implemented less restrictive policies; for example, commercial formularies for Express Scripts and Highmark Blue Shield do not have a prior authorization requirement for MAT drugs. Cigna may not be a pioneer, but their story represents the public awareness of the predicament and the solutions we are providing.

Solving the opioid problem requires a multidisciplinary approach. Other recent progresses include the President’s Mental Health and Substance Use Disorder Parity Task Force, the Comprehensive Addiction Recovery Act, FDA’s naloxone mobile application competition, and the new pain treatment guideline written by the CDC. Health care professionals, politicians, insurers, the criminal justice system, and the community as a whole are slowly but surely paving the way for a remedy.

Finally, stigma is an invisible but pervasive barrier to addiction treatment that we all can help remove. Entrenched societal attitudes are a significant challenge, but we have overcome them countless times throughout history and can do so again. It is now everyone’s responsibility to recognize that the acts labeled as criminal may be a cry for help. Rather than incarcerating people, we should be looking for ways to put them on the road to recovery.

Mimi Chen, PharmD, is a Clinical Services Manager at MediMedia Managed Markets and a part-time community pharmacist.