Cigna to implement prior authorization policy for opioid prescriptions

Use of prescribed opioid down close to 12 percent over 12 months 

among Cigna customers.

Starting July 1, Cigna will require prior authorization for physicians prescribing a long-acting opioid that is not being used as part of treatment for cancer or sickle cell disease, or for hospice care, the insurer said.

Also, most new prescriptions for a short-acting opioid will be subject to quantity limits, Cigna said.

In releasing its new safety measures, Cigna is following Centers for Disease Control and Prevention guidelines issued last year that recommend non-opioid therapy as the preferable treatment for chronic pain outside of cancer treatment, palliative and end-of-life care.

Nearly 62,000 doctors within 158 medical groups that are part of  Cigna collaborative care agreements have signed a pledge to reduce opioid prescribing and to treat opioid use disorder as a chronic condition. 

Cigna is working with doctors and providers by analyzing integrated claims data across pharmacy and medical benefits to detect opioid use patterns that suggest possible misuse by individuals.

The insurer alerts doctors when their opioid prescribing patterns are not consistent with CDC guidelines.

It established a database of opioid quality improvement initiatives for physicians to help them determine the next steps for improving patient care, including referrals into chronic pain management or substance use disorder treatment programs.

This may be a step in the right direction. The reduction of 13% in the use of opioids in Cigna's population is significant, but this is still in the short-term.

Alternative medication therapy as well as physical therapy, electrostimulation, meditation are all available.  Usually a patient will select one and if they do not have relief, physicians will prescribe other therapeutic methods.  The pathway for a patient can be circuitous and stressful.  Many are referred to pain specialists, placing a further burden on them. The use of the other medications are not without serious complications, somnolence, decreased cognition, and mood disorders.  Chronic pain exacerbates other mental disorders, increasing anxiety, irritability, sleep disorder, and isolation.

This pilot program, should it continue to demonstrate significant reductions could alter the pattern of opiod prescriptions.

Poppy seeds, the source for opium

Opiod dependence is a serious event for a patient and their families with multiple mental changes, and physical complication.

Cigna authorization personnel will be busy.

Cigna to implement prior authorization policy for opioid prescriptions