Reviews/Evaluations

Opioid Utilization Analysis

Patients included if have 1 opioid claim in CY2000

OMAP FFS Opioid Analgesic Cost Trend Per Member Per Month

OMAP FFS Opioid Analgesic Utilization Trend per 1000 Members per Month

Count of Patients at Various Opioid Claim Counts for CY2000

12% of the total patients on opioids in CY2000 got >12 claims. Those 12% received 53% of all opioid claims (117,974). 3.8% of patients got >24 claims in CY2000, but received 26.5% of all opioid claims (59,230).

Indicators of Opioid Abuse:

1. Accessing >3 pharmacies and >3 prescribers for opioid drugs
   (30% rate of unidentified providers in the data generates a number that likely under represents reality)
2. Repeated prescriptions for carisoprodol in addition to opioid drugs
   (Patients included if there was a single claim for carisoprodol)
3. Repeated attempts to refill prescriptions early
   (Patients identified if they had > 3 ER2 alerts. ER2 alerts are dependent upon accurate entry of "days supply" field by dispensing pharmacist. There is evidence this field is often underestimated for drugs dosed PRN and would therefore under-represent the extent of this problem)
   

Summary of opioid use by patients with > 3 opioid claims

Top 10 Drugs by Claim Count / Patient for patients receiving >24 opioid claims in CY2000 (n=1647)

Summary of Top 10 Drug Use by Risk Factor (patients may use > 1 drug)

Indicators of inappropriate pain management:

1. Use of meperidine, propoxyphene, mixed agonist-antagonists or antagonist drugs for more than 3 months.
   
   1076 unique provider numbers (excluding 999999, hospitals and clinics) prescribed drugs recommended for acute use only for >90 days. The average number of patients/provider was 2 (range 1 - 29). Only 25 providers prescribed these drugs chronically to more than 10 patients.

2. Use of meperidine, propoxyphene or methadone for elderly patients (>64 years old)
   
   1130 unique providers (excluding 999999, hospitals and clinics) prescribed these drugs. The average number of patients per provider was 2 (range 1 - 27). Only14 providers prescribed these drugs to > 10 elderly patients.
   
   Many of the same providers are identified as high prescribers of propoxyphene products for chronic use and to elderly patients.
   

3. Use of short-acting opioids (the same or multiple) continuously for more than 3 months without the addition of a long-acting opioid.
   
        N=10676 (25% of patients on any short-acting drug)
   
   
4. Continued concurrent use of duplicate short-acting opioids for 90 days. (Described in the claims as ratio of unique drug months/months of drug >1.5, a minimum of 3 months therapy was required to be included)
   
        N=1200 (2.8% of patients on any short-acting drug)
   
   
5. Continued concurrent use of different long-acting opioids for 90 days. (Described in the claims as ratio of unique drug months/months of drug >1.5, a minimum of 3 months therapy was required to be included)
   
        N=55 (1.2% of patients on any long-acting drug)
   
   

Utilization Trend of Dosage Forms of OxyContin® in CY2000

Average OxyContin®Dose / Day per Patient
(Calculated with "Days Supply" field)

Cost per Tablet Dispensed in CY2000

Provider Specialty Prescribing OxyContin®in CY2000

Provider Analysis for CY2000
(Total n=978 providers excluding clinics, hospitals and unidentified providers)

Most Frequent Diagnoses for New OxyContin® Patients in CY2000
(Total n=1454, 171 patients had no claim with ICD9)

Most Frequent Diagnosis for New MS Contin®, Duragesic®and Oramorph®Patients in CY2000
(Total N=1143, 251 patients had no medical claims with ICD9 code)

Conclusions

OxyContin costs have dramatically increased over the 2 years reviewed. This is primarily due to increased numbers of patients using the lower strengths. The cost per tablet and dose per patient-day have remained constant. The utilization of hydrocodone products has also increased considerably. There was no detectable decrease in other opioid utilization to account for these increases. There are geographic pockets of increased OxyContin prescribing by providers.

The great majority of patients using opioids have fewer than 4 opioid claims during the year. 12% of patients with >12 opioid claims are associated with 53% of all opioid claims, with approximately 4% (> 24 claims) associated with 26.5% of all opioid claims.

Patients meeting one risk factor for abuse are small, 1.65 - 3.79% of all patients associated with opioid claims. Only 63 (0.15%) met all three risk factors combined. The majority of these patients had claims for hydrocodone products and OxyContin. Propoxyphene products were associated with 40% of the high-risk patients.

A small number of providers routinely prescribed propoxyphene products chronically and to elderly patients. 19% of patients on meperidine were on it longer than 90 days. Short-acting opioids were used for longer than 90 days in the absence of long-acting products for about 25% of patients. Few problems with duplication of therapy were detected.

Finally, the most frequent diagnoses associated with long-acting opioids are below the OHP coverage line.