Opioids and safeguards to help protect older adults

April 1, 2024

In the United States, there are about one million adults aged 65 and older who have an opioid use disorder. Due to age-related pain syndromes and comorbidities, this population is at an increased risk of side effects, overdose, and death.*

Reducing the overuse and misuse of prescription opioids is top priority, the Pharmacy Quality Alliance (PQA) has identified three targets; (1) of opioids from Multiple Providers in Persons Without Cancer (OMP), (2). opioid high dosage (OHD) reduction, and (3) concurrent opioid and benzodiazepine (COB). 

Our approach to helping assure safe opioid prescription use

To help safeguard our customers and minimize their health risks, Cigna Healthcare takes a proactive approach to promoting safe opioid prescribing and a retrospective approach to addressing opioid prescribing concerns. We take the following multi-faceted approach that encompasses the elements below.

Formulary selection     Pharmacy and therapeutics (P&T) committee review
Utilization management
  • Quantity limits on most opioid pain medications
  • Prior authorization including relevant risk evaluation and mitigation strategy (REMS)
Point-of-sale logic/ concurrent drug utilization review
  • Opioid point-of-sale safety edits
  • Morphine milligram equivalent (MME) threshold and cumulative MME daily dose threshold
  • Opioid naive patients (have not used opioids for a certain period of time and may have larger reactions and stronger side effects)
  • Hard stop at the pharmacy for seven-day supply limit (unless state requirements are more restrictive)
Prescriber resources
  • Naloxone use
  • Safe prescribing practices
  • Substance use disorder support, including:
    • Medication-assisted treatment
    • Behavioral health
    Monitoring of prescribed opioids
    • Overutilization monitoring systems / Opioid Drug Management Program
    • Retrospective drug utilization review, including overuse monitoring
    Continuous improvement
    • Evaluate effectiveness of our programs and adapt for optimal reduction of prescription opioid abuse and diversion

    Access opioid tools and resources at:
    The Cigna for Health Care Professionals website (CignaforHCP.com) > Get questions answered: Resource > Pharmacy Resources > Pharmacy Clinical Programs > Opioid Resources.

    * Jaya Sri Konakanchi, MB, BS, et al. “The Growing Epidemic of Opioid Use Disorder in the Elderly and Its Treatment: A Review of the Literature.” Psychiatrist.com. 10 January 2023. Retrieved from https://www.Psychiatrist.com/pcc/growing-epidemic-opioid-use-disorder-elderly-its-treatment-review-literature.

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