2016 Drug Trends Series

Transcription

1 Drug Trends Series Part 3: Assessing opioids and compounds Published August Drug Trends Series Opioids & Compounds First Script

2 Introduction As with the first two editions in Coventry s Drug Trends Series, our analysis is based on all calendar-year transactions billed through our Pharmacy Benefit Management (PBM) program, First Script, as well as transactions from medical bill review to reflect the total pharmacy experience for our client base. This third installment of our series is dedicated to opioids and compound drugs. These two therapeutic classes are frequently discussed in workers comp as opioids are prescribed to treat pain associated with injuries and compounds have been growing in popularity with physician dispensers. We will share aggregate opioid and compound information which includes all drugs; we also will break out the results for comparison into the managed and unmanaged views. Highlights Aggregate prescription cost per claim, including both managed and unmanaged script usage, decreased 8.4% Opioid costs and utilization dropped significantly A 10.7% drop in utilization drove a 10.7% decrease in cost per claim. Opioids represented a smaller share of overall cost and utilization, declining 1.2% points and nearly 1% point, respectively. Although opioid trends have shown marked improvement for both the managed and unmanaged settings, differences in claim age and severity of injury have driven trends in opioid utilization, costs, and drug mix Opioid utilization continued to trend downward for the managed population, both on a per-claim basis (9.3%) and for the percentage of injured workers utilizing opioids (3.1% points). Similarly, the cost per claim has declined substantially (12.5%). Non-opioid medications used to treat pain are on the rise with the younger claim age population represented in the unmanaged setting. This helped reduce opioid utilization (down 19.7% per claim), cost (down 19.8% per claim), and the number of injured workers utilizing opioids (down 3.5% points). Utilization of compound medications continued to fall with the greatest impact occurring in the managed setting Managed The number of injured workers using compounds is 1%, nearly half of what it was in. Compound costs also dropped by half from, accounting for only 2.5% of all drug spend. Several key states (NY, CA, TX, PA, and IL) experienced a reduction of more than 50% in both the percent of claims using compounds and the percentage of cost associated with their usage. Unmanaged The number of injured workers using compounds fell to 3.1%; this is a drop of nearly 25% from. Costs associated with compounds accounted for 26.1% of all drug spend, down from 31.9% in. California, the state with the most injured workers using compounds, saw its compound user population drop 54%, from 7.1% to 3.3%. 1 Drug Trends Series Opioids & Compounds First Script

3 Aggregate View Data Includes Managed + Unmanaged Prescriptions The Aggregate View Represents: 100% of Total Pharmacy Cost 100% of Total Prescriptions The charts in this section incorporate all pharmacy transactions that have been shared in the two prior editions of our series. Comparisons between the traditional and aggregate views follow. Aggregate Key Trends Cost and Utilization Trend Changes ( to ) Per-claim costs for all prescription drugs decreased 8.4% between and. Opioids Top 10 Classes All Classes Eight of the top 10 drug therapy classes experienced lower costs in. Aggregate data indicated a greater decrease in opioid prescriptions and cost per claim, but a smaller decrease in compounds when compared with traditional data. There was a different injury mix for the unmanaged group. Opioid usage per claim Compound usage per claim Dermatological & topical medications Traditional: -8.5% Aggregate: -10.7% Traditional: -43% Aggregate: -24.8% Traditional: +1.3% Aggregate: +5.1% 2 Drug Trends Series Opioids & Compounds First Script

4 Aggregate View High-Impact Drug Classes Aggregate by Volume Aggregate by Volume Specialty Drugs Opioid use continued to decline in. Specialty Drugs Opioids Opioids Compounds All Other Classes Compounds All Other Classes The 1.2% point drop in opioid volume (shown above) has translated into a nearly 1% point drop in opioid cost (as shown in the chart below). Aggregate by Cost Specialty Drugs Aggregate by Cost* Specialty Drugs Opioids Opioids Compounds All Other Classes Compounds All Other Classes Compound cost fell 4.2% points, driven by decreases in both utilization per injured worker (24.8%) and cost per script (22.9%). *The numbers reflected in this and other charts throughout this report may not add up to 100% due to rounding. 3 Drug Trends Series Opioids & Compounds First Script

5 Opioid Trends There has been a slow yet continuous shift away from opioid medications to nonopioid therapies. In both the managed and unmanaged populations, opioid prescriptions are increasingly being replaced with nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and muscle relaxants. To better understand the drivers behind this welcome trend, we have analyzed some of the differences in opioid utilization and cost across claim ages in both the managed and unmanaged populations. Top Opioid Trends, Managed Top 5 Opioid Medications Ranked by Utilization Managed Prescriptions Trend - Medication % of Total % of Total Scripts Cost Opioid Scripts Opioid Cost per Claim per Claim Hydrocodone/ 33.1% 9.9% -11.9% -22.1% acetaminophen Oxycodone/ 15.2% 18.5% -7.5% -8.7% acetaminophen Tramadol 14.3% 4.0% -4.4% -9.0% Oxycodone 9.8% 6.9% -3.2% -12.2% OxyContin 5.9% 20.7% -10.6% -8.7% All other opioids 21.7% 40.0% -11.8% -13.7% All opioids -9.3% -12.5% The top 5 most utilized opioids, shown here, accounted for 78.3% of utilization and 60% of cost for all opioids The number of injured workers using opioids dropped from 57.3% to 54.2% Nucynta Nucynta ER Only two opioids among the top 20 experienced increasing trends in cost per claim. Both Nucynta and Nucynta ER, 8.4% cost per claim 31.4% cost per claim schedule II controlled substances well suited for pain conditions requiring a strong opioid component, had price increases above 24%. 4 Drug Trends Series Opioids & Compounds First Script

6 Top Opioid Trends, Unmanaged Top 5 Opioid Medications Ranked by Utilization Unmanaged Prescriptions Trend - Medication % of Total % of Total Scripts Cost Opioid Scripts Opioid Cost per Claim per Claim Hydrocodone/ 29.9% 10.4% -29.2% -34.9% acetaminophen Tramadol 26.7% 11.7% -10.8% -7.7% Oxycodone/ 9.9% 14.9% -19.0% -11.4% acetaminophen Acetaminophen/ 8.2% 1.7% -9.9% -0.8% codeine Tramadol/ 6.3% 1.7% -12.1% -42.2% acetaminophen All other opioids 18.9% 59.7% -20.6% -20.0% The top 5 most utilized opioids, shown here, accounted for 81.1% of utilization and 40.3% of cost for all opioids The number of injured workers using opioids dropped from 24.3% to 20.8% All opioids -19.7% -19.8% Extended-release tramadol #6 in utilization #1 in cost per claim 29% 32.6% Extended-release tramadol declined substantially for utilization and cost per claim. 5 Drug Trends Series Opioids & Compounds First Script

7 Opioid Utilization by Claim Age Opioid Utilization by Claim Age Managed Prescriptions* 70.4% of all managed opioid scripts are for claims aged 3+ years. Greater medical severity among the managed population drives opioid usage that results in an average of 5 opioid scripts per injured worker using opioids in Managed claims tend to be older with an average claim age of 5.8 years compared with 2.1 years for unmanaged. Injured workers filling opioids in the managed setting contrast significantly in medical severity and drug mix with their unmanaged counterparts. Opioid usage per claim* continues to decline in almost all claim ages for both the managed and unmanaged population. Opioid Utilization by Claim Age Unmanaged Prescriptions* Only 32.5% of all unmanaged opioid scripts are for claims aged 3+ years Less severe injuries among the unmanaged population yields an average of 2 opioid scripts per injured worker using opioids in *Opioid claims only 6 Drug Trends Series Opioids & Compounds First Script

8 Opioid Cost by Claim Age Opioid Cost by Claim Age Managed Prescriptions* Cost per script for opioids has fallen 3.5% with 7 of the first 10 claim age years experiencing decreases Opioid Cost by Claim Age Unmanaged Prescriptions* Overall cost per script for opioids has experienced a negligible decrease of 0.04% Cost decreases in claims aged 1-3 years (73.9% of opioid scripts) have been offset by increases in per script costs for more mature claims. *Opioid claims only 7 Drug Trends Series Opioids & Compounds First Script

9 Compound Trends Aggregate View Compounds Represent: 7.7% of Aggregate Cost 1.3% of Aggregate Prescriptions Injured Workers Filling At Least One Compound Prescription The percentage of injured workers filling compound prescriptions for both the managed and unmanaged populations declined by roughly 1% point Compounds per claim dropped for both populations: 44.2% for managed and 15.4% for unmanaged. Compound Cost The percentage of drug costs associated with compounds declined 2.9% points for the managed population and 5.8% points of the unmanaged population. Compound drugs represented only 2.5% of total drug costs in the managed population as compared with 26.1% of total drug costs in the unmanaged population 8 Drug Trends Series Opioids & Compounds First Script

10 Compound Utilization in Top States Ranked by Total Drug Cost Compound Utilization in Top States Managed Prescriptions While not in the top 10 states by total drug cost, 6.1% of scripts in Colorado were for compounds the highest for all states. NY, CA, TX, PA, IL, and CT each experienced a more than 50% reduction in the percentage of all claims utilizing compounds. The top 10 states accounted for 47.5% of all injured workers using compounds Compound Utilization in Top States Unmanaged Prescriptions Five of the top 10 states incurred increasing trends, with CO experiencing the greatest increase at 66.7%. California s 54% reduction in injured workers utilizing compounds was the key driver behind the decrease in unmanaged compound use. California accounted for 31.3% of all compound claims 9 Drug Trends Series Opioids & Compounds First Script

11 Compound Cost in Top States Ranked by Total Drug Cost Compound Cost in Top States Managed Prescriptions Among the top 10 states, Texas had the highest percentage of cost for compounds at 6%. The percentage of total managed drug costs dropped at least 50% for compounds in NY, CA, TX, PA, and IL. The top 10 states accounted for 60% of all managed compound cost Compound Cost in Top States Unmanaged Prescriptions The top 10 states accounted for 79.6% of all compound cost with CA, PA, and TX representing 59.6%. The percentage of total unmanaged drug costs dropped at least 30% for compounds in CA, GA, and NY. California experienced the greatest reduction at 43.9% 10 Drug Trends Series Opioids & Compounds First Script

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13 Conclusion & Recommendations The opioid and compound drug trends highlighted in this installment of our Drug Trends Series illustrate the progress made on an aggregate level as well as the differences in these drug categories between the managed and unmanaged populations. As stated in our second installment, understanding the differences between the managed and unmanaged populations allows us to tailor solutions for each of these populations. The managed prescription population tends to be made up of injured workers facing greater medical severity and longer-duration claims. The higher rate of opioid utilization in the managed population confirms the importance of directing injured workers to network pharmacies where clinical oversight is most impactful. This allows the PBM to work closely with the prescribers to reduce opioid utilization and identify opportunities for addiction screening and opioid disorder assessments. It is encouraging to see trends in both opioid utilization and cost continuing to decline across the aggregate view of claims. This is attributable, in part, to increased attention concerning inappropriate prescribing of opioids and the risks associated with this class of drugs; these include misuse, abuse, and death from overdose. Our early intervention efforts have helped drive down opioid utilization over time as well. Extended-release (ER) or long-acting opioid medications are more commonly utilized within the managed injured worker population. These types of opioids are associated with unique risks and present an opportunity to analyze drug mix and ensure that evidence-based recommendations for use are appropriately reflected in the patient s treatment plan. These recommendations may include the presence of a pain treatment agreement with routine physician evaluation of the continued need for ER opioids, the presence of rescue medication where appropriate, ongoing urine drug monitoring, and ultimately return to work/function for the injured worker. Compound utilization and cost declined for both the managed and unmanaged populations in. Payors who leverage processes allowing only compound prescriptions expected to provide medical benefit will continue to see a decline in both utilization and cost. In our next installment of the Drug Trends Series, we will consider future trends, including specialty drugs and drug formularies. 12 Drug Trends Series Opioids & Compounds First Script

14 First Script is the Pharmacy Benefit and Drug Utilization Management Program offered as part of the Coventry suite of products. First Script offers an end-to-end program designed specifically for workers compensation. We realize that getting 100% of the prescriptions into the network isn t the end game; it s what you do with those scripts that matters. Early triage of each injured worker ensures that injured workers know how and where to get a prescription filled, and permits us to intervene aggressively on potentially problematic opioid utilization at the earliest point possible. Through integration with our bill review and case management programs, we are positioned to capture all prescription activity for utilization and total pharmacy risk management, ensuring that we manage not only the First Script, but Every Script. Coventry is the leading provider of care and cost management solutions for workers' comp, disability, and auto insurance carriers, third-party administrators, and self-insured employers. We design best-in-class products and services to help our partners return injured workers to work, to play, and to life as quickly and as cost effectively as possible. We accomplish this by developing and maintaining consultative partnerships with our clients and stakeholders, built on a foundation of trust that supports the claims management process. Coventry Connect Mobile Industry leading care and cost management solutions on the go Coventry Connect technology works with Coventry s integrated suite of solutions to help adjusters and case managers make informed decisions that lead to better Coventry Workers Comp Services 3200 Highland Ave. Downers Grove, IL Coventry Health Care Workers Compensation, Inc. All rights reserved. The information which is provided herein is offered as a courtesy to our clients. All material is intended for information, communication, and educational purpose only and is in no manner an endorsement, recommendation, or approval of any information. Coventry accepts no liability for the content of this distribution, or for the consequences of any actions taken on the basis of the information provided. 13 Drug Trends Series Opioids & Compounds First Script