As with many of Donald Trump's other political initiatives, tackling an issue generally requires the promotion of a clear winner that will act as a means of achieving an objective while realizing significant benefits for the role being played. In the case of the opioid crisis, this approach means encouraging insurance companies to marginalize economic dynasties with a historical role in the creation of the crisis, while promoting competing organizations by granting them almost exclusive access to markets such as Florida, where they will scoop up the value of contracts previously held by Oxycontin producers.
Oxycontin's problems have been building up for most of the year. Insurance giant Cigna, Aetna and Blue Cross have all been forced to begin taking measures to combat opioid addiction, as research increasingly indicates that the cost to public and private insurance companies of prescription painkiller abuse, treatment and "diversion" (when patients sell the medication instead of taking it) is an estimated $72.5 billion a year. The approach has so far been two fold: ending coverage of opioids, while working with the federal government to reward parties who provide products which will help curb the epidemic.
In the case of Cigna, these measures have translated an announcement that they will end their coverage of Oxycontin starting in 2018. The move is coupled with a new contract with Collegium Pharmaceutical, a producer of an oxycodone equivalent (Xtampza ER) with abuse deterrence properties. In Florida, a major hotspot for opioid addiction, the state's largest insurer Florida Blue also abandoned Oxycontin for Collegium's Xtampza ER. As with Cigna, the shift will also occur on Jan 1st, 2018.
Federal regulatory agencies have further rewarded Collegium by approving the company to make the claim that Xtampza is the only opioid on the market with an oral abuse deterrent. Coupled with Trump's vows to stamp out the opioid crisis, such a designation is a significant reward to a corporation willing to work with the federal government in assisting with a solution to the health crisis.
While Collegium has been heavily promoted as the alternative to Oxycontin, a heavyweight rival and the main producer of the opiate, Purdue Pharmaceutical, has found itself in the sights of federal prosecutors. The Oxycontin giant came under fire after a Los Angeles Times investigation found that Purdue's claim of 12 hour relief brought by the drug ignored evidence that the drug failed to last that long in some patients and lead to withdrawal, addiction and abuse. Purdue's owners, the Sackler family, are oft reviled for the the billions in profits they have realized due to their role in developing Oxycontin.
The loss of the Florida market alone might not be a fatal blow to Purdue, but it will no doubt provide a welcome boost to Collegium which the company will be able to repeat it's feat in other states. Dr. John A. Fallon, a member of Collegium's Board of Directors, has previous work experience with Blue Cross Blue Shield of Massachusetts, part of the same national network as Florida Blue. These ties put Collegium's ability to cut deals with Blue Cross members and raises the possibility that this kind of deal may be repeated in other states.