Cigna, Anthem Take Steps to Curb the National Drug Epidemic

Cigna and Anthem, which are potentially merging in the future, both announced they were taking steps to curb inappropriate opioid and prescription drug use.

Cigna and Anthem, which are potentially merging in the future, both announced they were taking steps to curb inappropriate opioid and prescription drug use.

Anthem announced that its affiliated health plans launched a program on April 1, 2016, to help reduce addiction to opioids and other prescription drugs and improve drug safety by enrolling high-risk members and individuals and employer-sponsored plans in the company’s Pharmacy Home Program, which limits drug coverage to one member-chosen home pharmacy.

The company said it is using the program to focus on a small but extremely high-risk segment of health plan members in 14 states. (Those with diagnoses or prescription histories of HIV, sickle-cell anemia, multiple sclerosis, cancer, and hospice and palliative care are exempt from the program.) Members with increased safety risk and candidates for the Pharmacy Home Program meet these 3 criteria within a 90-day period:

  • They filled 5 or more controlled substance prescriptions, or filled 20 or more prescriptions, not limited to controlled substances.
  • They visited 3 or more healthcare providers for controlled substance prescriptions, or 10 or more providers not limited to controlled substances.
  • They filled controlled substances prescriptions at 3 or more pharmacies, or filled prescriptions for 10 or more pharmacies not limited to controlled substances.

The Pharmacy Home Program notifies prescribers in writing of the decision to include the member in the program. The prescriber will also receive a 3-month member prescription history and an education piece on the advantages of one pharmacy to review with the member.

Cigna’s program will start cutting the use of opioids among its own customers by 25% over 3 years, returning to 2006 levels, before the opioid and prescription drug crisis. To achieve this goal, the company will tap into its extensive experience with prevention, wellness, and chronic disease management programs and will work with clients, physicians, and others to develop ways to increase prevention and treatment of substance use disorders. Cigna will encourage the rapid adoption of the new CDC guidelines on opioid use, prescribing opioids for the shortest time possible to treat acute pain, and talking with clients about all options and risks before long-term therapy.

Cigna will treat substance use like other chronic diseases, using an evidence-based and holistic approach that combines behavioral therapy with medications to treat substance use disorders. The company is working with its network to ensure medication-assisted therapy is readily available as part of a comprehensive treatment program.

The company is supporting efforts to require prescribers to check state Prescription Drug Management Program databases when prescribing more than a 21-day supply of a painkiller such as oxycodone or morphine. Cigna will also limit the quantity of painkillers when appropriate, and explore additional controls for high-risk customers identified by the company’s data.