Oxycodone Hydrochloride Extended-Release Commercial Coverage Update

In response to the opioid epidemic that continues to grip many areas of the nation, Harvard Pilgrim is committed to improving access to abuse-deterrent pain management options. To support that, we are updating our commercial formularies in January to promote the use of abuse-deterrent pain treatment instead of traditional opioids that may be abused.

Harvard Pilgrim currently covers Xtampza ER (oxycodone extended release capsules) — an abuse-deterrent, oral formulation of oxycodone ER — without prior authorization at the preferred brand tier on the Premium, Value, and Core NH commercial formularies. Xtampza ER is approved by the FDA for the management of chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment when non-opioid options are inadequate.

Effective Jan. 1, 2021, Oxycontin (oxycodone HCL extended release tablets) will no longer be covered on the Premium formulary. Oxycontin will be placed at the highest cost-share tier and will require prior authorization on the Value and Core NH formularies. Requests for coverage of Oxycontin will be considered based on medical necessity — and if a request is approved, the patient would be responsible for a higher copayment.

The chart below displays the coverages, as of Jan. 1, for oxycodone products, brand and generic included, on the Premium, Value, and Core NH commercial formularies:

Premium 2021  Value 2021  Core NH 2021
Xtampza ER capsules
(9mg, 13.5mg, 18mg, 27mg, 36mg)
Preferred brand
Preferred brand  Preferred brand
Oxycontin tablets
(10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg)
Non-Formulary  Highest tier with PA  Highest tier with PA
Oxycodone ER tablets
(10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg)
Non-Formulary  Highest tier with PA  Highest tier with PA
Oxycodone ER capsules
Non-Formulary  Non-Formulary  Non-Formulary

Why Xtampza ER is preferred

Harvard Pilgrim’s decision was based on the effectiveness of Xtampza ER’s abuse-deterrent formulation. Oxycontin was recently reformulated and is now also available in an abuse-deterrent formulation, but the new formulation and mechanism remain inferior to Xtampza ER. Xtampza ER utilizes a proprietary abuse-deterrent technology called DETERx microspheres, which provides adequate pain control while preserving its extended-release profile after cutting, crushing, or chewing. Oxycontin does not maintain its extended-release profile after manipulation; it utilizes a physiochemical barrier and once manipulated it forms a viscous hydrogel intended to prevent misuse or abuse. A small study published in 2015 in JAMA psychiatry found that 34% of abusers admitted that they successfully defeated the extended-release mechanism of Oxycontin.

Transitioning patients from Oxycontin to Xtampza ER

To avoid any disruption in therapy, providers may transition their patients from Oxycontin to Xtampza ER prior to Jan. 1.

Before switching a patient, there are some factors providers should first consider:

  • All other around-the-clock opioid drugs should be discontinued prior to initiating Xtampza ER therapy.
  • Xtampza ER is not bioequivalent to other opioid products, and it is important to carefully monitor patients for possible dosage adjustments.
  • Xtampza ER includes an oxycodone base as opposed to the oxycodone hydrochloride found in Oxycontin. As a result, dosages are slightly different than current oxycodone HCl products. For example, a 10 mg dose of Oxycontin is equal to a 9 mg dose of Xtampza ER. An equivalence chart is provided below. However, providers should review the full prescribing information found in the FDA-approved label and monitor patients during the transition.

  • There are no established conversion ratios from other opioids to Xtampza ER defined by clinical trials; patients’ treatment should be initiated with a conservative Xtampza ER 9 mg dose (equivalent to 10 mg oxycodone HCl) taken orally every 12 hours with food.

Please refer to the FDA’s Xtampza ER full prescribing information for more details. For more information on Harvard Pilgrim’s formularies, please visit the Pharmacy section of Harvard Pilgrim’s provider website.

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