December 2018

Enhanced Narcotic Therapy Management Program working to identify opioid risks

Cigna is committed to helping improve our customers’ health, and possibly save lives, by identifying and supporting those at-risk for opioid misuse or possible overdose. Our goal is to reduce overdose among our enrolled customers by 25% by December 2021.1

In March 2018, Cigna reached its goal of reducing opioid use by 25% among our commercial customer base – one year ahead of schedule.2

One program to help us reach our goal of reducing overdose among customers has recently been enhanced. The Cigna Narcotic Therapy Management program now helps to identify a greater range of customers who may be at-risk for substance use disorder or overdose.

We studied current program insights and clinical expertise and then expanded the criteria which identifies research. Using our findings, we then expanded the criteria which identify at-risk substance use patterns. These include:

  • Prescriptions from multiple physicians and pharmacies
  • High prescription volume or very high daily dose
  • High net dose along with other non-opioid medications.

Integrated medical, pharmacy, and behavioral benefits, along with partnering with prescribers, allow for better management of our customers' overall health and wellness. We offer to clients that integrate administration of their benefits with Cigna interventions, programs and services in a way that clients who carve out administration of some of their benefits to other carriers cannot.

The Cigna Narcotic Therapy Management program at work:

  1. Identify – Uses combined benefit data to form a complete picture of a customer’s medical condition and prescription drug use. Then it flags individuals who may be at risk for misuse or abuse of opioids. We calculate a morphine milligram equivalents (MME) score – a sum of the total daily dose of opioids for which a customer receives coverage. This number offers insight into who might be at risk for addition or overdose.
  2. Guide – The program identifies unsafe dosing patterns. It triggers prior authorization edits that help to ensure the plan covers the appropriate amount/dose of opioids.
  3. Offer Options – Fully engages physicians when the program flags one of their patients. Once made aware of the utilization, the provider may opt to restrict at-risk patients to just one physician or pharmacy for prescription narcotics. He or she may also counsel the patient, discuss pain management alternatives, prescribe overdose rescue or detox medication, make referrals and/or connect with Cigna programs.
  4. Community Advocacy – Assists with referrals to Cigna Behavioral Health to explore treatment options and in-and outpatient facilities, if necessary.
  5. Reduce – Helps to reduce inappropriate use and create better health outcomes through proper opioid management.

For more information about the Narcotic Therapy Management program, click here.

Visit Cigna's new pain resource hub, which provides educational material and resources about pain, how it manifests, how it’s treated, and ultimately, how to manage it as safely as possible.

For more information on Cigna’s ongoing efforts and other programs to fight opioid abuse, click here.

  1. Initial focus will be on targeted U.S. communities where a sizable number of Cigna commercial customers reside and where there are higher incidences of overdose. These include: Connecticut, Maryland, New Jersey, Virginia, Chicago, New York City, Philadelphia, Washington, DC.
  2. Cigna press release, Cigna’s Partnership With Physicians Successfully Reduces Opioid Use By 25 Percent – One Year Ahead of Goal, March 2018. https://www.cigna.com/newsroom/news-releases/2018/cignas-partnership-withphysicians-successfully-reduces-opioid-use-by-25-percent-one-year-ahead-of-goal

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