How One Insurer Plans to Cut Customers’ Opioid Use By 25% in 3 Years

May 19, 2016, 6:33 PM UTC
Pill bottles with white generic pills
Photograph by Gary S Chapman — Getty Images

Health insurer Cigna (CI) announced on Thursday an ambitious goal of slashing its customers’ use of potentially addictive opioid pain medications by 25% over the next three years.

The move is in response to the widespread opioid and heroin overdose epidemic in the U.S. The 25% reduction target would bring Cigna plan holders’ use of the drugs back to the “pre-crisis” levels of 2006, according to the company.

America’s recent and growing troubles with opioid painkiller addiction has caught public health officials and the medical community by surprise. “I think in hindsight over the last 20 years, we’re able to now see that, gosh, we missed this,” said Doug Nemecek, chief medical officer for Cigna’s behavioral health business, in an interview with Fortune. “Back in the mid-90s when [the popular opioid painkiller] OxyContin came out and other novel pain medications, they were promoted as having less of a risk of addiction. Physicians were educated that these drugs were safe and not to worry about addiction … and to concentrate on treating people’s pain.”

The rest is history. Government data show that more than 165,000 Americans died from prescription painkiller overdoses between 1999 and 2014. Thousands more have overdosed on heroin, a portion of whom moved to the drug after developing an opioid addiction. The crisis has reached such a fever pitch that Purdue Pharma, the privately held company that makes OxyContin, has come under scrutiny over its possible role in propagating the epidemic.

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Now, the question facing the medical community and lawmakers is, what’s the best way to buck the trend?

For Cigna, the answer is a multi-pronged approach that begins with educating physicians and patients about the risks of opioid painkillers and new CDC guidelines for prescribing the narcotics. But there’s also a major data-driven component to the effort, examining “how [Cigna] can share with physicians data on prescribing patterns so they have the most current information on what their patients are actually taking,” said Nemecek.

“We had a program for several years that looked for patterns of abuse and fraud in narcotic prescriptions. And we’re expanding that with the new CDC guidelines to include not just fraud or clear abuse, but looking at patients who have prescribing patterns that put them at risk for addiction.” That might mean screening patients who are on particularly high-dose opioid regimens that last more than 21 days, or those who are prescribed a combination of drugs that might make them more vulnerable to addiction.

But any effort to cut opioid use must also grapple with the reality that many patients are in real chronic pain and need strong medication to get through the day. In response, Cigna plans to promote more holistic and alternative pain management therapies.


“We don’t want to just take narcotics away from people who need them,” Nemecek emphasized. “What we are going to do with physicians is really expand the availability and access to more comprehensive chronic pain treatment programs…. Treatments like cognitive behavioral therapy, which is usually used for depression, is also very effective for chronic pain. Using alternative treatments like massage, chiropractic services where appropriate—we’re going to be working with physicians to give them more alternatives to medications.”

And for Cigna customers who have already developed a substance use disorder, the insurer aims to ensure access to rehabilitation and treatment programs and promote initiatives that take the stigma out of addiction.

The data from Cigna’s experiment could offer valuable lessons for future treatment. The insurer recently teamed up with the American Society of Addiction Medicine (ASAM) to share customer claims data in an effort to glean the most effective methods of tackling addiction treatment.

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