Florida Blue says they will no longer cover OxyContin for most customers

Move is reaction to opioid epidemic, says insurance giant

JACKSONVILLE, Fla. – Florida Blue, the largest health insurer in Florida, announced Tuesday that it will not cover OxyContin in its commercial lines of business starting Jan. 1, 2018. 

As a replacement, the insurance giant said that Xtampza ER will be covered as the preferred long-acting oxycodone product. Xtampza ER is a new oxycodone formula developed specifically to help prevent abuse of the drug. It is approved by the Federal Drug Administration to manage severe pain that requires long-term opioid treatment. 

Medicare Advantage products are excluded from this policy change, according to a statement by Florida Blue.

Florida Blue is taking this step as one part of its efforts to fight the opioid epidemic in Florida. Following the Center for Disease Control declaring a national opioid epidemic earlier this year, Florida Gov. Rick Scott signed an executive order proclaiming the opioid epidemic in Florida a statewide emergency. Toxicology results determined that opioids were present at the time of death in 4,515 Floridians last year, according to the 2016 interim report from the Florida Medical Examiners Commission.

“People who abuse OxyContin typically try to tamper with the drug by crushing it, creating a higher and faster acting dose that can be snorted or injected. This type of consumption can quickly lead to addiction and overdose,” said Scott McClelland, Pharm.D., vice president of commercial and specialty pharmacy at Florida Blue. “After careful review of the scientific data supporting the abuse-deterrent features of Xtampza ER, we decided to replace OxyContin on the formulary and believe this will be an important step to addressing the opioid epidemic among the people we serve in the state.” 

The policy change related to OxyContin is intended to support appropriate use of opioid usage for members suffering from chronic pain, Florida Blue said.

"The objective is to protect both members and their families from the risk of opioid abuse and misuse, while providing continued access to opioid medications when appropriate," the company said in a statement.

Florida Blue also said that it is working with its pharmacy benefit manager to identify and manage physicians whose opioid prescribing patterns raise concerns. The company said that it utilizes a special investigation unit that works closely with local and federal law enforcement agencies when prescriber data identifies potential fraudulent activity. Florida Blue said they also established case management programs related to opioid usage that focuses on member education and safety.