Stark County Safety Council Presentation: Opioid & Anti-Anxiety Medication Use Among Ohio s Injured Workers
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1 Stark County Safety Council Presentation: Opioid & Anti-Anxiety Medication Use Among Ohio s Injured Workers June 11, 2015 John Hanna, R.Ph. BWC, Pharmacy Director 6/24/2015 BWC Pharmacy Program Overview 1
2 Discussion Overview The BWC Pharmacy Program & Mission How the Mission is Accomplished Impact on Drug Utilization Impact on Opioids Mission Focus Going Forward 6/24/2015 BWC Pharmacy Program Overview 2
3 The BWC Pharmacy Program 2014 vs ,022 Injured Workers received an Rx (-26%) 990,369 Prescriptions covered (-36%) $113.4M total prescription cost (-16%) Average Unit cost/rx = $ (+8.2%) Average Rx Cost/Injured Worker=$2, (+13.7%) Generic Dispensing Rate = 83.4% (+4.8% vs 13) Each 1% Increase in GDR = $3.35M cost savings 6/24/2015 BWC Pharmacy Program Overview 3
4 The Pharmacy Program Mission Manage drug utilization to ensure coverage for necessary medications to allow proper care of injured workers in a fiscally responsible manner. 6/24/2015 BWC Pharmacy Program Overview 4
5 The Pharmacy Tools Formulary Relatedness Drugs & Prior Authorization Requirements Drug Utilization Reviews 6/24/2015 BWC Pharmacy Program Overview 5
6 Formulary Impact: Drug Utilization 2014 vs 2010 o24% fewer Injured workers received opioids o Opioid prescriptions (-38%) o 48% fewer Injured workers received muscle relaxants o Muscle relaxant prescriptions (-72%) o 79% fewer injured workers received anti-ulcer drugs o Anti-Ulcer prescriptions (-83%) 6/24/2015 BWC Pharmacy Program Overview 6
7 Formulary Impact: Drug Costs 2014 vs 2010 Total drug costs: -$22.8 million (-16.8%) o Opioids: -$19.9 million (-36%) o Muscle relaxants: -$2.8 million (-78%) o Anti-ulcer drugs: -$6.4 million (-95%) 6/24/2015 BWC Pharmacy Program Overview 7
8 Automated Rx Edits: Relatedness List Drugs In 2014 Automated Edits Applied in the pharmacy on all Rxs Stopped initial coverage of 235,000 Rxs Relatedness List Edits May require a PA Apply to 373 of 405 drug classes Matches drug indication & allowed conditions 3900 PAs processed by the PBM Pharmacists 4400 PAs processed by BWC staff 6/24/2015 BWC Pharmacy Program Overview 8
9 Automated Rx Edits: Formulary & Special Claim Edits Rxs for certain formulary drugs require a PA SR Opioids, Muscle Relaxants, Testosterone Some require an allowance Fentora, Lidoderm,Suboxone Special Claims Edits Medical Only Claims All require a PA after 60days from DOI Claims with no prescriptions for 270 days Require a PA for any prescription 6/24/2015 BWC Pharmacy Program Overview 9
10 Drug Utilization Reviews 2014 BWC-MCO Workgroup Recommendation Transition this activity to the MCOs DUR workgroup began work in June New process developed Pilot of new process began in November 2014 Transition to all MCO s 7/1/ DURs performed by BWC/MCOs in DURs performed by MCOs in /24/2015 BWC Pharmacy Program Overview 10
11 Injured Workers Receiving Medications 2001 to , ,000 98,352 97,337 95,539 97,286 90,000 91,376 87,178 82,331 All injured workers receiving prescriptions 80,000 75,109 70,000 60,000 50,000 40,000 30,000 56,889 63,602 65,881 68,825 69,858 66,611 67,406 63,937 65,338 60,923 60,821 55,115 56,398 51,712 49,957 50,211 47,680 43,140 39,427 Injured workers receiving opioids 34,458 20, /24/2015 BWC Pharmacy Program Overview 11
12 80% Injured Workers Receiving Opioids % 73% 73% 74% 73% 74% 74% 73% 70% 69% 71% 71% 70% 69% 65% 65% 60% 58% 55% 50% /24/2015 BWC Pharmacy Program Overview 12
13 Opioid Utilization Opioid doses per injured worker receiving opioids /24/2015 BWC Pharmacy Program Overview 13
14 Opioid Utilization Annual opiate load per injured worker receiving opioids (Mg MED/IW) /24/2015 BWC Pharmacy Program Overview 14
15 BWC Opiate Utilization 2010 vs o BWC s opiate dependency guideline: 60mg MED/Day for 60 days o In fourth quarter ,689 injured workers received this dose of opiates 13% of all injured workers receiving medications in 2010 were opiate dependent. 17% of injured workers receiving opioids o In fourth quarter 2014: 5,469 injured workers met it; 11% of all injured workers receiving medications. 16% of injured workers receiving opioids 6/24/2015 BWC Pharmacy Program Overview 15
16 Top 10 Highest Opiate Prescribers 2010 vs High dose opiate prescribers - 4th quarter 2010 High dose opiate prescribers - 4th quarter 2014 Prescriber Patients with total Mg MED/day > 399 Patients with total Mg MED/day Patients with total Mg MED/day Patients with total Mg MED/day > 999 Prescriber Patients with total Mg MED/day > 399 Patients with total Mg MED/day Patients with total Mg MED/day Patients with total Mg MED/day > 999 Dr. A Dr. B Dr. C Dr. D* Dr. E* Dr. F Dr. J* Dr. H 9 9 Dr. I Dr. J* 8 8 Dr. B Dr. K** Dr. L Dr. M Dr. N Dr. O 6 6 Dr. P Dr. Q Dr. A** Dr. W 5 5 6/24/2015 BWC Pharmacy Program Overview 16
17 Acute to Chronic Opioid Use In New Claims Date of Injury (DOI) 2011 vs IWs with DOIs in 2011 Totals Percent of 2011 total IWs with DOIs in 2013 Totals Percent of 2013 total 2011 vs Percent change IWs that received RX prior to July ,448 IWs that received RX Prior to ,001-29% IWs with "acute" opiate script (RX with 28 days) 4,754 56% IWs with acute opiate script ( RX with 28 days) 3,452 58% -27% IWs with ongoing opiate script (RX after 84 days) 4,483 53% IWs with ongoing opiate script (RX after 84 days) 2,755 46% -39% IWs with acute and ongoing opiate Rx after July ,531 18% IWs with acute and ongoing opiate Rx after July % -44% 6/24/2015 BWC Pharmacy Program Overview 17
18 BWC Opioids Year Total prescribers Total patients Total prescriptions Total drug quantity Average quantity per Rx Average MED per Rx January June ,543 37, ,197 18,277, July December ,720 36, ,005 18,180, January June ,132 35, ,746 17,228, July December ,980 33, ,240 16,192, January June ,563 31, ,583 15,272, July December ,303 29, ,599 14,334, January June ,991 28, ,887 13,518, July December ,880 26, ,790 12,878, January June ,592 25, ,951 12,186, July December ,102 23, ,652 11,161, /24/2015 BWC Pharmacy Program Overview 18
19 Total Ohio Opioids Year Total prescribers Total patients All Ohio Average quantity per Rx All Ohio Average MED per Rx BWC Average quantity per Rx BWC Average MED per Rx January June ,256 1,865, July December ,500 1,908, January June ,148 1,889, July December ,778 1,954, January June ,983 1,978, July December ,671 2,088, January June ,862 1,923, July December ,852 1,918, January June ,769 1,882, Source: Oho Board of Pharmacy 2014 Annual OARRS Report 6/24/2015 BWC Pharmacy Program Overview 19
20 2011 vs 2014 Opioid Dependence (Injured Workers Above 60mg MED/Day) mg MED mg MED mg MED mg MED mg MED > 1000 mg MED 2011 Opiate Dependent IWs 2014 Opiate Dependent IWs 6/24/2015 BWC Pharmacy Program Overview 20
21 Opioid Use By Age of Injured Worker Age ranges IW's per Age Band 2014 IW's per Age Band 163 6/24/2015 BWC Pharmacy Program Overview 21
22 Percentage of Opioid Use By Injured Worker Age Q vs Q % 60.00% 62% 66% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 19% 16% 14% 11% 7% 0.04% 4% 1% 0.04% 0.5% Age Band Pct of Total 2014 Age Band Pct of Total 6/24/2015 BWC Pharmacy Program Overview 22
23 Anti-Anxiety Agent Utilization ,000 Injued Workers Receiving Benzodiazepines 70,000 60,000 67,406 65,338 60,821 56,398 50,000 50,211 40,000 30,000 20,000 10,000 10,350 9,912 9,073 8,314 7, /24/2015 BWC Pharmacy Program Overview 23
24 Anti-Anxiety Agent Utilization % 14.0% Percent of IW's with Anti-anxiety Drugs 15.4% 15.2% 14.9% 14.7% 15.5% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% /24/2015 BWC Pharmacy Program Overview 24
25 Benzodiazepine Use By IW Ages /24/2015 BWC Pharmacy Program Overview 25
26 18.00 Avg Daily Anti-Anxiety Drug Load (mg/iw) /24/2015 BWC Pharmacy Program Overview 26
27 Opiates and the Injured Worker Five Ohioans die every day due to unintentional drug poisoning. Between 2006 to 2013, on average, one injured worker died every week due to drug overdose. Ove half of the injured worker drug overdose deaths in 2013 also involved a benzodiazepine An injured worker was over three times more likely to die from drugs than the general population. 20overdose%20data/1finalCB_2012_Bullets%20for%20reporters%20on%20drug%20related%20poisoning.ashx 6/24/2015 BWC Pharmacy Program Overview 27
28 Going Forward o Implement an automated process to identify high risk medication regimens and trigger direct clinical staff contact with the prescriber. o Establish an opioid prescribing rule based on best clinical practices for both prescribing as well as discontinuing these drugs. o Initiate a retail pharmacy based medication therapy management program to coordinate medications in high risk claims. 6/24/2015 BWC Pharmacy Program Overview 28
29 Thank You! Questions?
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