Record numbers of Americans are dying of opioid overdoses, yet medication-assisted treatment (MAT) – a key tool for those fighting addiction – is utilized far too infrequently. Cigna Healthcare is working to change that as part of a broader strategy to reduce overdoses from drugs such as fentanyl, heroin, and oxycodone.

Cigna Healthcare began rolling out an overdose reduction strategy pilot program in 2018 that includes access to providers who offer MAT treatment in five Cigna markets (Connecticut, Chicago, Mid-Atlantic, New York City/New Jersey, and Philadelphia). By the end of 2021, opioid overdoses among Cigna customers eligible for the pilot program fell by 18%. “MAT is the gold standard of helping customers deal with their substance-use addiction,” said Dr. Scott Josephs, Cigna’s chief medical officer.

In comparison, Cigna Healthcare saw opioid overdoses increase by 16% in areas not yet targeted by the new strategy during the same period, which included the first two years of the COVID-19 pandemic. “COVID has led to increased loneliness and mental health disorders such as stress and depression, which has exacerbated this epidemic of opioids,” Dr. Josephs said.

Under this strategy, Cigna Healthcare helps patients understand the treatments and other options covered under their benefit, which can include counseling, peer recovery support, behavioral case management support, and use of medications including buprenorphine, methadone, and naltrexone to treat opioid addictions. The medications serve a number of functions, including helping normalize the patient’s brain chemistry, blocking the intoxicating effects if the patient continues to use opioids, and reducing or eliminating cravings for the drugs.

MAT programs are offered in a variety of inpatient, outpatient, or virtual settings. For example, Bicycle Health’s virtual opioid use disorder (OUD) treatment, available in 24 states, is part of Evernorth’s behavioral health network and is available to Cigna Healthcare health plan customers in employer-sponsored plans or who have coverage through marketplace exchange plans.

How Cigna Healthcare Is Working To Reduce Overdoses

Battling this epidemic requires a multipronged approached. Many addictions begin with a prescription for opioid pain killers before progressing to illegal drugs, which are more deadly and easier to obtain.

Cigna Healthcare uses data-driven programs to monitor the amount of opioids prescribed to individual patients and offers opioid education to patients and providers. For example, Cigna sends letters to every pharmacy customer who fills a prescription for an opioid for the first time, outlining the risks and safer therapeutic options. We notify prescribers if their patients are at risk for overdose so they can take action, and we act proactively, suggesting alternative therapies when customers are taking high levels of opioids. All these tools help keep our customers safe.

In an innovative new overdose reduction strategy, Cigna Healthcare is using data to identify barriers to appropriate care, including when providers do not prescribe MAT and when we identify a lack of referrals to appropriate in-patient treatment. We use integrated data from pharmacy, medical, and behavioral benefits to flag potential issues, then we intervene as early as possible to ensure optimal care.

Cigna Healthcare case managers, including Lisa Osborne, steer customers to treatment facilities, virtual care, and access to behavioral case managers – whatever combination is appropriate for the individual.

“We'll get a message saying somebody needs help immediately,’” said Osborne, who’s a licensed professional counselor. “They’ll say, ’There's somebody that we have on the line right now that would like to speak to a case manager.  Can someone talk right now?’”

Lydia’s Story: From Life-Threatening Overdose to Recovery

One of the opioid reduction strategy’s many success stories is Lydia (not her real name). She was 24 when she overdosed on fentanyl. The quick administration of Narcan saved her life, and she was rushed to the emergency room. When she was admitted to the hospital, Cigna Healthcare was notified, as were the caseworkers who support customers who are dependent on opioids.

Osborne was assigned to help Lydia. She learned that in addition to her opioid addiction, Lydia has bipolar disorder. Her parents were strong supporters of her efforts to stop using opioids and had helped her through several stays in treatment facilities.

The first step in working with Lydia was an in-depth assessment, Osborne said, determining her previous efforts toward recovery and other lifestyle factors. “We use all the resources we have to know exactly what they need, what is best for them, and how to best keep them alive. We make sure that they have the connections they need, and guide them,” she said.

A big part of that is suspending judgment. “There’s none of that,” she said. Instead, the focus is helping customers understand their options.

“I'm going to monitor your case,” she tells customers. “I'm going to follow it, and I'm going to make sure when you are discharged or you finish treatment that I'm here for you. I'm going to follow up with you, I’m going to make sure you’re filling your medications, and I'm going to make sure that you know that you're not alone.”

Lydia is a success story. She worked on her addiction throughout her stay in the treatment facility, and she got the support she needed – including medications – as she continued the recovery process.

“Lydia’s story is one person, but there's so many,” Osborne said. “We do crisis calls every day.”