2016 drug trends series · 5 2016 drug trends series opioids & compounds irst script top opioid...
TRANSCRIPT
1 2016 Drug Trends Series – Opioids & Compounds First Script
2016 Drug Trends SeriesPart 3: Assessing opioids and compounds
Published August 2017
1 2016 Drug Trends Series – Opioids & Compounds First Script
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 2015.• Compound costs also dropped by half from 2015, 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 2015.• Costs associated with compounds accounted for 26.1% of all drug spend, down from 31.9% in 2015.• California, the state with the most injured workers using compounds, saw its compound user population
drop 54%, from 7.1% to 3.3%.
Introduction
Highlights
As with the first two editions in Coventry’s 2016 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.
2 2016 Drug Trends Series – Opioids & Compounds First Script
Cost and Utilization Trend Changes (2015 to 2016)
Aggregate View Data Includes Managed + Unmanaged Prescriptions
Aggregate Key Trends
The Aggregate View Represents:
100% of Total Pharmacy Cost
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 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.
OpioidsTop 10 ClassesAll Classes
Per-claim costs for all prescription drugs decreased 8.4% between 2015 and 2016.
Eight of the top 10 drug therapy classes experienced lower costs in 2016.
100% of Total Prescriptions
Compound usage per claim
Opioid usage per claim
Traditional: -8.5% Aggregate: -10.7%
Dermatological & topical medications
Traditional: +1.3%Aggregate: +5.1%
Traditional: -43% Aggregate: -24.8%
3 2016 Drug Trends Series – Opioids & Compounds First Script
Aggregate View — High-Impact Drug Classes
Specialty Drugs Specialty Drugs
Compounds Compounds
2016 Aggregate by Volume
2016 Aggregate by Cost*
2015 Aggregate by Volume
2015 Aggregate by Cost
Opioid use continued to decline in 2016.
Compound cost fell 4.2% points, driven by decreases in both utilization per injured worker (24.8%) and cost per script (22.9%).
Opioids Opioids
All Other Classes All Other Classes
Specialty Drugs
Compounds
Opioids
All Other Classes
Specialty Drugs
Compounds
Opioids
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).
*The numbers reflected in this and other charts throughout this report may not add up to 100% due to rounding.
4 2016 Drug Trends Series – Opioids & Compounds First Script
Opioid Trends
Top Opioid Trends, Managed
There has been a slow yet continuous shift away from opioid medications to non-opioid therapies. In both the managed and unmanaged populations, opioid prescriptions are increasingly being replaced with non-steroidal 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.
2016 Trend 2015-2016
Medication %ofTotal %ofTotal 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%
Allopioids -9.3% -12.5%
Top 5 Opioid Medications Ranked by Utilization – Managed Prescriptions
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, schedule II controlled substances well suited for pain conditions requiring a strong opioid component, had price increases above 24%.
8.4%cost per
claim
31.4%cost per
claim
5 2016 Drug Trends Series – Opioids & Compounds First Script
Top Opioid Trends, Unmanaged
2016 Trend 2015-2016
Medication %ofTotal %ofTotal 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%
Allopioids -19.7% -19.8%
Top 5 Opioid Medications Ranked by Utilization – Unmanaged Prescriptions
The number of injured workers
using opioids dropped from
24.3% to 20.8%
The top 5 most utilized opioids,
shown here, accounted
for 81.1% of utilization and 40.3% of cost for all opioids
Extended-release tramadol
#6 in utilization #1 in cost per claim
Extended-release tramadol declined substantially for utilization and cost per claim.29% 32.6%
6 2016 Drug Trends Series – Opioids & Compounds First Script
Opioid Utilization by Claim Age
Opioid Utilization by Claim Age – Managed Prescriptions*
Opioid Utilization by Claim Age – Unmanaged Prescriptions*
20152016
20152016
*Opioid claims only
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 2016
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 2016
Opioid usage per claim* continues to decline in almost all claim ages for both the managed and unmanaged population.
Injured workers filling opioids in the managed setting contrast significantly in medical severity and drug mix with their unmanaged counterparts.
Managed claims tend to be older with an average claim age of 5.8 years compared with 2.1 years for unmanaged.
70.4% of all managed opioid scripts are for claims aged 3+ years.
7 2016 Drug Trends Series – Opioids & Compounds First Script
Opioid Cost by Claim Age
Opioid Cost by Claim Age – Managed Prescriptions*
Opioid Cost by Claim Age – Unmanaged Prescriptions*
20152016
20152016
*Opioid claims only
Cost per script for opioids has fallen
3.5%with 7 of the first
10 claim age years experiencing
decreases
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.
Overall cost perscript for opioidshas experienced
a negligibledecrease of
0.04%
8 2016 Drug Trends Series – Opioids & Compounds First Script
Compound Trends — Aggregate View
Injured Workers Filling At Least One Compound Prescription
Compound Cost
2013201420152016
2013201420152016
The percentage of injured workers filling compound prescriptions for
both the managed and unmanaged
populations declined by roughly
1% point
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
populationThe percentage of drug costs associated with compounds declined 2.9% points for the managed population and 5.8% points of the unmanaged population.
Compounds per claim dropped for both populations: 44.2% for managed and 15.4% for unmanaged.
Compounds Represent:
7.7% of Aggregate Cost
1.3% of Aggregate Prescriptions
9 2016 Drug Trends Series – Opioids & Compounds First Script
Compound Utilization in Top States Ranked by Total Drug Cost
Compound Utilization in Top States – Managed Prescriptions
Compound Utilization in Top States – Unmanaged Prescriptions
20152016
20152016
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.
The top 10 states accounted for
47.5% of all injured workers
using compounds
NY, CA, TX, PA, IL, and CT each experienced a more than 50% reduction in the percentage of all claims utilizing compounds.
Five of the top 10 states incurred increasing trends, with CO experiencing the greatest increase at 66.7%.
California accounted for
31.3% of all compound
claimsCalifornia’s 54% reduction in injured workers utilizing compounds was the key driver behind the decrease in unmanaged compound use.
10 2016 Drug Trends Series – Opioids & Compounds First Script
The top 10 states accounted for
60% of all managed
compound cost
California experienced the
greatest reduction at
43.9%
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 79.6% of all compound cost with CA, PA, and TX representing 59.6%.
Compound Cost in Top States Ranked by Total Drug Cost
Among the top 10 states, Texas had the highest percentage of cost for compounds at 6%.
The percentage of total unmanaged drug costs dropped at least 30% for compounds in CA, GA, and NY.
Compound Cost in Top States – Managed Prescriptions
Compound Cost in Top States – Unmanaged Prescriptions
20152016
20152016
11 2016 Drug Trends Series – Opioids & Compounds First Script
12 2016 Drug Trends Series – Opioids & Compounds First Script
Conclusion & Recommendations
The opioid and compound drug trends highlighted in this installment of our 2016 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 2016. 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.
13 2016 Drug Trends Series – Opioids & Compounds First 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.
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 Connect® MobileIndustry 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 outcomes.
3200HighlandAve.•DownersGrove,IL•60515•800.243.2336•www.coventrywcs.com©2017CoventryHealthCareWorkersCompensation,Inc.Allrightsreserved.
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.
Coventry Workers’ Comp Services@CoventryWC