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The largest insurer in Tennessee has announced it will no longer cover prescriptions for what was once a blockbuster pain reliever. It鈥檚 the latest insurance company to turn against OxyContin, whose maker, Purdue Pharma, faces dozens of lawsuits related to its high-pressure sales tactics around the country and contribution to the opioid crisis. Last fall,聽听补苍诲听聽both dropped coverage of the drug.

Top officials at BlueCross BlueShield of Tennessee say newer abuse-deterrent opioids work better, and starting in January, the insurer covering 3.5 million Tennesseans will pay for those opioids made by other pharmaceutical companies instead.

鈥淲e felt it was time to move to those products and remove Oxycontin from the formulary, which does still continue to have a higher street value,鈥� said Natalie Tate, the insurer鈥檚 vice president of pharmacy.

OxyContin was聽聽to make the drug harder to misuse 鈥� but it鈥檚 still possible to crush or liquefy in order to snort or inject it.

The latest long-acting opioids that BlueCross BlueShield of Tennessee is going to start covering 鈥� Xtampza and Morphabond 鈥� are still more difficult to misuse, according to the company and some pharmaceutical experts.

Motives Questioned

In a page-long response a reporter鈥檚 query, a Purdue Pharma spokesman pointed out that no opioid drug is 鈥渁buse proof鈥� or less addictive, accusing BCBST of financial motives that remove choices for many patients.

鈥淲e believe that patients should have access to FDA-approved products with abuse-deterrent properties,鈥� Purdue鈥檚 Robert Josephson wrote in an email. 鈥淭he recent decision by BlueCross BlueShield of Tennessee limits prescribers鈥� options to help address the opioid crisis.鈥�

In response, BCBST鈥檚 Tate argued that ditching one of the most recognized names in opioids is not designed to save money, though it could in a roundabout way.

This move could reduce fraudulent prescriptions to street dealers or drug-seeking people with active addictions and cut down on costly hospital stays for overdoses, said pain consultant and pharmacist Jeff Fudin, an adjunct professor at Albany College in New York.

鈥淚t鈥檚 a smart idea to use dosage forms that have proven to have been better abuse-deterrent formulations,鈥� he said. 鈥淚n the long run, it actually will cost them a whole lot less money.鈥�

Fudin said he鈥檚 often at odds with insurers over their decisions about which drugs to cover, but he applauds this decision, which he expects more insurers to follow.

Alternative Therapies

Practicing pain physicians in Tennessee 鈥� who regularly battle with insurance companies 鈥� also approve of the change, though they said OxyContin was already falling out of favor. And they argue trading one opioid for slightly safer ones doesn鈥檛 address a larger gripe that physicians have with insurers over paying for other, non-addictive types of treatment.

鈥淲e will have denials and prior authorizations on a muscle relaxer, and we will have no issue getting an opioid through the insurance company,鈥� said Dr. Stephanie Vanterpool, an anesthesiologist at the University of Tennessee and the president-elect of the Tennessee Pain Society.

鈥淭he physicians or the doctor鈥檚 offices jump through hoops to get the better medication for the patients,鈥� said Vanterpool. 鈥淎nd when I say better medication, I mean the medication that鈥檚 treating the cause of the pain, not just the medication that鈥檚 covering up the pain.鈥�

BlueCross BlueShield of Tennessee is adding some alternative pain therapies in the coming year, according to its聽. But Vanterpool would like to see a philosophical about-face.

Not to say OxyContin won鈥檛 be sorely missed by some patients.

鈥淭here are plenty of people who benefit from that drug,鈥� said Terri Lewis, a patient advocate and rehabilitation specialist from Cookeville, Tenn.

She鈥檚 suspicious of BCBST鈥檚 motives since the insurer may be blamed for its role in the opioid crisis. Embattled Purdue Pharma could be a convenient scapegoat.

鈥淢aybe this is a good decision,鈥� Lewis said. 鈥淏ut it smells like a political decision.鈥�

And this would be just the latest decision inserting politics into a nuanced medical problem.

A Blessing In Disguise?

The Tennessee legislature instituted some of the聽聽this year 鈥� a three-day limit for most people who aren鈥檛 already on opioids. And even long-term pain patients are having trouble getting refills.

John Venable of Kingsport, Tenn., was shown the door by his pain clinic in July after more than a decade on oxycodone 鈥� a generic, short-acting version of OxyContin.

鈥淚 just felt like I was in a hopeless state, like, 鈥榯here is no help for John,鈥欌�� he recalled.

At their worst, he said his headaches get so debilitating 鈥渢hat death would be a relief.鈥� Despite his dread, he鈥檚 noticed something surprising over the last few months without opioids 鈥� his crippling headaches haven鈥檛 gotten that much worse, if at all.

鈥淚t very well might be a blessing in disguise,鈥� Venable said.

The retired builder and one-time pastor said he prays that those losing OxyContin also will get to use the moment as an opportunity, though he knows many can鈥檛 cut ties with opioids. And he worries some will turn to more dangerous drugs off the street or even contemplate ending their own lives.

Experts point out that the number of opioid prescriptions has already been falling around the country. And in Tennessee, BCBS has experienced a 26 percent drop in opioid prescription claims over three years.

But restricting legal access to opioids hasn鈥檛 turned back the rise in overdose deaths,聽聽and nationwide last year.

This story is part of a partnership that includes , and Kaiser Health News.

麻豆女优 Health News鈥� coverage of prescription drug development, costs and pricing is supported in part by the .