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Major insurer Cigna — which is engaged in an effort to reduce abuse of prescription painkillers — announced Wednesday that it will effectively stop covering the cost of use of the opioid OxyContin by customers of its employer-based health plans beginning in January. 
  
 At the same time, Cigna announced a contract to continue covering a competing oxycodone alternative to OxyContin, which will impose a financial penalty on that drug's maker if too much of the drug ends up being used by the insurer's customers. 
  
 Oxycodone is used to treat moderate to severe pain. 
  
 Cigna's moves come more than a year after the insurer said it intended to cut opioid use among its customers by 25 percent by 2019. 
  
 The announcement also comes two months after President Donald Trump said the opioid-abuse crisis is a "national emergency." 
  
 There were more than 33,000 opioid-related deaths in 2015, the highest tally on record, according to the federal Centers for Disease Control and Prevention. 
  
 More than half of those deaths were linked to prescription opioids such as OxyContin. The rest were related to heroin or to fentanyl, a synthetic opioid. 
  
 "Our focus is on helping customers get the most value from their medications — this means obtaining effective pain relief while also guarding against opioid misuse," said Jon Maesner, Cigna's chief pharmacy officer on Wednesday. 
  
 OxyContin is the only opioid-based prescription painkiller that Cigna is removing in 2018 as "a preferred option" from its formulary, or list of medications that its health plans will pay for. 
  
 While Maesner said that Cigna would review individual prescriptions for OxyContin that are deemed "medically necessary" by a physician, the drug essentially is "being removed" from coverage by the insurer. 
  
 Cigna said that people who have already started using OxyContin for hospice care or cancer treatments will continue to have that medication covered next year. 
  
 Cigna said it has begun notifying customers who currently have OxyContin prescriptions, as well as their doctors, of the decision to stop covering the opioid "so that they have time to discuss treatment options and covered oxycodone clinical alternatives. 
  
 Maesner, who would not identify how many Cigna customers currently use OxyContin, said the insurer is "not specifically singling out Oxycontin." 
  
 But, he added, "we found a strong sense of commitment" to reducing opioid overuse from Collegium Pharmaceuticals, the maker of the oxycodone alternative that Cigna will continue to cover. 
  
 However, a spokesman for Purdue Pharma, the privately held Connecticut company that makes OxyContin, suggested there is little, if any, difference in between the two opioids in how they affect patients. 
  
 The spokesman, Robert Josephson, said OxyContin and Xtampza ER, the opioid that Cigna is continuing to cover, are both long-acting oxycodones. 
  
 Josephson also noted that both OxyContin and Xtampa ER are formulated in a way to deter abuse. 
  
 "We believe that patients should have access to FDA [Food and Drug Administration]-approved products with abuse deterrent properties," Josephson said. 
  
 "Unfortunately, Cigna's decision limits the tools prescribers can use to help address the opioid crisis as both products are formulated with properties designed to deter abuse." 
  
 Xtampza ER is made by Collegium Pharmaceutical. 
  
 Cigna said that under the terms of the contract the insurer signed with Collegium that kicks in Jan. 1, "Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold." 
  
 "If the threshold is exceeded, Collegium will reduce the cost of the medication for many of Cigna's benefit plans," Cigna said. 
  
 Purdue Pharma has been sued by a number of states and cities in the past year for alleged deceptive marketing of its opioids. 
  
 "I don't know how executives at Purdue sleep at night," State of Washington Attorney General Bob Ferguson said last week as he announced one of those lawsuits accusing the drugmaker of downplaying the addictiveness OxyContin. 
  
 Purdue Pharma, which has declined the suits' claims, has noted that its products account for only 2 percent of all opioid prescriptions. 
  
 In 2007, the company and three Purdue Pharma executives pleaded guilty to federal criminal charges related to misbranding of OxyContin. Purdue Pharma agreed to pay $600 million in fines and other payments, while the executives agreed to pay $34.5 million in fines. 
  
 Cigna in 2016 announced a goal of slashing use of opioids among its customers by 25 percent over the next three years. Cigna said that as part of that initiative it would encourage doctors to prescribe the drugs in lesser quantities and for lesser amounts of time. 
  
 Last April, the insurer said opioid use among Cigna customers had already declined by 12 percent. ||||| (CNN) In an attempt to reduce opioid use amid a nationwide abuse epidemic , insurance giant Cigna will no longer cover most OxyContin prescriptions in its group plans beginning January 1. 
  
 "Our focus is on helping customers get the most value from their medications -- this means obtaining effective pain relief while also guarding against opioid misuse," Cigna Chief Pharmacy Officer Jon Maesner said in a statement Wednesday. 
  
 OxyContin is a brand name for an extended-release version of oxycodone, a commonly prescribed opioid painkiller. 
  
 Long-acting or extended-release medications like OxyContin contain a higher dosage of the active ingredients in the pill itself, which is chemically released over a long period of time. The advantage for patients is that they don't have to take pills as frequently. However, the higher dosage of long-acting pills can make them more attractive for abuse. Crushing or melting some versions of extended-release pills, a user can get a day's dosage in just one pill. 
  
 According to Cigna, "Xtampza ER's abuse-deterrent platform allows the product to maintain its extended release profile even when cut, crushed, chewed or otherwise manipulated." OxyContin likewise has some abuse-deterrent properties, such as being more difficult to crush. And although one study appeared to find that Xtampza was harder to abuse than OxyContin, it was conducted by the medication's manufacturer, Collegium. 
  
 The difficulty of abuse shouldn't be confused with how addictive a drug may be, said Dr. Caleb Alexander, director of the Johns Hopkins Center for Drug Safety and Effectiveness. "People don't recognize that just because they are harder to tamper with doesn't make them any less addictive or any more effective in chronic non-cancer pain," he said. 
  
 Despite any advantages Xtampza may have, "people still get addicted to oral pills. They can still take too much. They can still overdose," said Dr. Walid Gellad , co-director of the University of Pittsburgh's Center for Pharmaceutical Policy and Prescribing. 
  
 Purdue Pharma, maker of OxyContin, said in a statement Thursday that "Cigna's decision limits the tools prescribers can use to help address the opioid crisis as both products are formulated with properties designed to deter abuse. Unfortunately, this decision appears to be more about pharmaceutical rebates." 
  
 Gellad and Alexander also believe that there was more to Cigna's decision than a desire to combat the opioid crisis. "I think it's important to recognize that insurers are trying to find the sweet spot between finding the right spot clinically and the right thing to do for their business," Alexander said. 
  
 In its statement, the insurance company said that "Collegium is financially accountable if the average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold. If the threshold is exceeded, Collegium will reduce the cost of the medication for many of Cigna's benefit plans." 
  
 When asked for further details of the financial agreement, including what the threshold was and the how cost reduction would be distributed, Cigna said that "specific terms of the contract are proprietary." 
  
 Dr. Charles E. Argoff, president of the American Academy of Pain Medicine Foundation, said "we are going down a very bad slippery slope if we allow payers to only make decisions solely on financial grounds and don't have any checks and balances on the insurance world's ability to basically dictate what happens to them medically." 
  
 Cigna said OxyContin will still be considered for patients if a doctor believes it medically necessary. 
  
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 According to the US Centers for Disease Control and Prevention , over 90 Americans die every day from opioid overdoses, including legally prescribed drugs like oxycodone as well as illicit drugs like heroin. Since 1999, the number of opioid overdose deaths has quadrupled, as has the number of opioid prescriptions. However, there hasn't been a change in the amount of pain reported by Americans. 
  
 Drug overdoses overall are killing more Americans than guns or car accidents. 
  
 But Gellad said that targeting prescriptions alone will not be enough to help turn the tide on the opioid overdose epidemic. "If you really want to address the opioid epidemic, it's about about increasing access to non-opioid treament for chronic pain patients." |||||
A big change for a huge insurance company: Starting Jan. 1, Cigna will stop covering most OxyContin prescriptions in its group plans. OxyContin, an opioid painkiller, is an extended-release version of oxycodone; extended-release versions contain a higher dose of the active ingredients, which can make them ripe for abuse as some versions can be crushed or melted in order to get the full dose immediately. "Our focus is on helping customers get the most value from their medications—this means obtaining effective pain relief while also guarding against opioid misuse," Cigna's chief pharmacy officer said in a statement Wednesday. He said that Cigna would review individual prescriptions deemed "medically necessary" by doctors, CNBC reports. The insurance giant has a goal of reducing its customers' opioid use by 25% over the next three years, CNN reports. Instead of OxyContin, Cigna has signed a contract with Collegium Pharmaceutical for the drug Xtampza ER, which is equivalent to oxycodone but is able to "maintain its extended release profile even when cut, crushed, chewed, or otherwise manipulated," Cigna says. However, it's not clear whether Xtampza ER is meaningfully more difficult to abuse than OxyContin (one study says yes, but it was conducted by the drug's manufacturer) and experts say even if a drug is hard to abuse, it can still be quite addictive. "People still get addicted to oral pills. They can still take too much. They can still overdose," says one doctor. Some are also raising questions about the financial agreement between Cigna and Collegium, and in its response to the news, the maker of OxyContin claimed Cigna's move is "more about pharmaceutical rebates" than keeping customers safe.