Blue Cross and Blue Shield of Alabama has announced new changes to its opioid policy, including a decision that the insurer will no longer cover the standard formulation of OxyContin.

The news, released Tuesday, is at least the second time this year that the insurer has changed its handling of opioids. In March it set a seven-day limit on “initial fills” of short-acting opioids such as Lortab, Vicodin and Percocet, and required additional authorization for first-time prescriptions of long-acting opioids such as OxyContin. Those changes, which took effect April 1, also included a generic copay for overdose antidote Naloxone.

The new changes to Blue Cross’ Opioid Management Strategy for commercial members take effect Jan. 1. Changes don’t entirely eliminate coverage for OxyContin, but shift coverage to variants thought to be less subject to abuse.

OxyContin and its generic version, oxycodone ER, will no longer be covered. But Xtampza ER, a new formulation of oxycodone ER, will be. Abusers often crush extended-release painkillers such as OxyContin into powder, to get more of the drug into their systems faster; various medical references describe Xtampza ER as a formulation designed to thwart that approach.

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“Xtampza ER maintained its ER characteristics after crushing, unlike many other commercially available opioid formulations, including some formulated with abuse-deterrent properties,” found one study. “As such, Xtampza ER may be less appealing to abusers and offer a margin of safety for patients who manipulate dosage forms to facilitate swallowing.”

Blue Cross and Blue Shield also will cover Roxybond, “a new instant release OxyContin formulation that is considered ‘abuse deterrent’ by the FDA,” the insurer said.

It also will cover Lucemyra, which it described as “the first non-opioid approved drug to treat the symptoms of opioid withdrawal.” The FDA announced in May 2018 it had approved the drug primarily for short-term use but did not rule out other possiblities. “Lucemyra is not a treatment for opioid use disorder (OUD) but can be used as part of a broader, long-term treatment plan for managing OUD,” said an FDA statement.

“Over the last two years, opioid prescriptions for Blue Cross and Blue Shield of Alabama’s commercial members have decreased 18 percent,” the insurer said in a statement released Tuesday. “While progress is being made, this issue calls for continued action by all parties.”

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