Florida Blue to stop OxyContin coverage to help fight opioid abuse

Carrier will replace it with alternative, Xtampza

WEST PALM BEACH, Fla. - OxyContin has become one of the most recognizable brands in the nation's deadly opioid epidemic.

And starting Jan. 1, Florida's largest health insurance will stop coverage of the addictive drug.

Florida Blue announced a few months ago that they will instead replace it with an alternative called Xtampza -- which is more chemically suited to prevent users from crushing, snorting or injecting it.

"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, vice president of commercial and specialty pharmacy at Florida Blue, in a statement. "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."

Wellington mother Peggy Hernandez has been fighting her own war against opioids. 

"It's a pain I can't describe," she said. "That pain of losing a child, it puts a hole in your heart. I'd be lying if I said I didn't have a hole in my heart."
 
Her son Ty Hernandez died last year of an opioid overdose when he was just 23 years-old. The family has spent the past year crusading for tougher laws against the addictive drugs and the people that sell them illegally.

The family is working to build a foundation in his honor, called Ty's Guiding Light. They've created a Facebook page to help connect with other parents in need of support.

"I miss him," she said tearfully during an interview with WPTV on Friday. "But his death will not be in vain. The law got changed. And we have numerous things that are in the works. I think the drug companies are started to see that we have a problem."

She says Florida Blue's announcement to drop OxyContin January 1 is bittersweet.

"I feel bad on one part for the person that absolutely is in desperate need of pain relievers, but I feel elated that we're moving into the right direction," she said. "Any type of pain medication is always going to have its negatives and positives. Positive -- yes, it takes the pain away. Negative -- you can get addicted to it. Negative -- it can cause other problems and you have to take it more than one time to get the pain relief."

Florida Blue's new policy will not apply to generic Oxycodone and doctors say any change from brand name to generic would be minimal.

Dr. Jonathan Adelberg with Treasure Coast Medical Associates said while it can be a good thing that the insurance carrier is switching to a drug that's more difficult to abuse, he's not confident the move will make much difference in opioid crisis overall.

"I don't believe that this is going to significantly change the opiate abuse or the rate of opiate abuse. I think really in a lot of ways, Blue cross is changing their coverage from one brand of orange juice, to another brand of juice. And people are still going to drink orange juice" he said.  "I believe stopping coverage probably has more to do with cost prevention for Blue Cross Blue Shield."

Florida Blue said the policy change is intended to support appropriate use of opioid usage for those suffering from chronic pain. The objective is to protect people from the risk of opioid abuse and misuse, while providing continued access to opioid medications when appropriate.

Dr. Adelberg said it might have to go beyond this new policy.

"The harsh realities of opiate addiction have to do with the permanent changes in the neurochemistry in someone who is addicted to opiates. And that doesn't change or ever go away -- evidenced by multiple studies done over the years using image enhanced MRIs -- that show those changes in a person's brain when they get addicted to opiates, doesn't go away with abstinence."

He added until we address that neuro-chemical permanent change that people who are addicted to opiates have, he doesn't believe there will be a solution to the crisis.

"Without these medications, there's a whole lot less tools in our armament as doctors to deal with pain. As a solution evolves for the opiate crisis, it has to include preserving the ability for people who actually need opiates legitimately and therapeutically to have access to them under a controlled environment," said Dr. Adelberg.

While Hernandez hopes those who depend on opioids can find relief she doesn't want another family to feel the pain she felt in losing a child.

"I never want a mother or father to feel this pain," she said. "I believe the key is everybody working together as a whole."

Florida blue says the OxyContin ban applies to all individual and group plans. Medicare advantage plans are excluded.

The state reports that opioids were the direct cause of more than 2,600 overdose deaths in 2016.

"I hope in 2018, we have some type of reduction in the deaths. I pray for that every night," said Hernandez.
 

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