New checkpoint helps opioid users after a medical emergency

Cigna remains committed to the fight against opioid misuse and overdose. We continue to seek out new ways to help meet our goal to reduce overdoses among our commercial customers in key markets by 25% by December 2021.1 Even in spite of what’s happening with the COVID-19 emergency, we will not relent on our efforts to curb opioid overdose. This issue doesn’t stop, so we won’t stop either. A new outreach effort works to identify and reach out to opioid users with a recently detected medical emergency. Our goal is to help lead them to beneficial resources that might reduce their risk for overdose.

We use claims data to determine if a customer with risk factors for opioid use disorder has had a medical emergency within a lookback period of 90 days. This triggers a Cigna Behavioral Health case manager* to reach out by phone to attempt to speak to the identified customer and engage in a thoughtfully worded conversation. The goal is to encourage the customer to speak with their health care provider about the situation and, if appropriate, learn about Medication-Assisted Treatment (MAT) – a gold standard, evidence-based treatment for opioid use disorder.2 MAT is a covered program for customers that combines counseling and behavioral support to help reduce the use of opioids.

Identified customers are encouraged to take advantage of their access to Behavioral Telehealth, an online video conferencing service that makes it easy to talk with a provider online, at a time that fits the customer’s schedule. All that’s necessary is a smartphone, tablet or computer. Customers can expect to pay the same-of-pockets costs for a video visit interaction with their health care provider as they would for an in-office visit. This is true for all clients.

We also use claims data to monitor prescribing patterns for high-risk individuals. As of June 2020, we now send a secure report/letter to prescribers of customers identified as high risk. The letter explains that the patient meets one or more risk factors for opioid-related overdose and highlights all the support resources available to the provider and patient to help reduce this risk. These resources include coaching, support, as well as opioid and chronic pain case management. The letter also describes lock-in capabilities, available when appropriate, to limit a patient’s coverage to a single pharmacy or prescriber of opioids. 

For more about Cigna’s actions to reduce opioid overdoses, please review these resources:

  1. Initial focus will be on the following 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. Substance Abuse and Mental Health Services (SAMHSA) Advisory Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. U.S. Department of Health and Human Services (HHS) Publication No. (SMA) 16-4938. Printed 2016.

* Depending on the customer’s coverage, they may or may not have access to Behavioral Health case management. Customers are advised to check their plan materials, or call the number on the back of their Cigna ID card, to find out what behavioral health services their plan covers.

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Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of prescription drug coverage, contact a Cigna representative.

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