Cost, use of opioid dependence treatment are increasing, spurring need for care management programs

October 7, 2014

Understanding the patterns and costs associated with opioid dependence treatments is important when developing and improving care management programs for plan members, according to 2 studies by pharmacy benefit manager Prime Therapeutics LLC (Prime).

Understanding the patterns and costs associated with opioid dependence treatments is important when developing and improving care management programs for plan members, according to 2 studies by pharmacy benefit manager Prime Therapeutics LLC (Prime).

“This knowledge can help ensure successful therapy for our members and prevent waste,” said Cathy Starner, PharmD, senior health outcomes researcher at Prime.

In 2011, approximately 5.1 million people in the United States abused prescription pain relievers (e.g. opioids). Clinical treatments for opioid dependence include detoxification or maintenance treatment, which entails the use of buprenorphine, buprenorphine/naloxone, naltrexone or methadone.

Prime researchers analyzed pharmacy and medical claims data of 12 million commercial members from 12 health plans between Jan. 1, 2011, and Dec. 31, 2013. Claims included all buprenorphine and all naltrexone-containing products. Researchers looked at the overall and state-specific total paid amounts (health plan plus member paid) and per member per month (PMPM) trends. The second study included all commercially insured members in one southern Blue Cross and Blue Shield plan that had a claim for a product with buprenorphine during 2012 and 2013.

According to the studies:

· Overall, buprenorphine total paid PMPM increased by 38% and the buprenorphine and naloxone sublingual film drove the increase

· The 2 highest buprenorphine expense states were located in the south and had PMPMs of $0.727, up 53% from 2011, and $0.557, up 22% from 2011.

· The second study identified 5,564 members using buprenorphine during 2012 through 2013 and found their average length of therapy was approximately 9 months.

· Five percent of members had 60 or more days supply of opioid during their buprenorphine treatment and one in every seven members had 3 or more prescribers for the buprenorphine.

“Formulary managers and managed care executives are interested in developing preferred drug lists and managed care programs that result in the most cost-effective medication use, which can not be done without an understanding of utilization trends.”

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