Drug Trends Series Part Three 2017 - coventrywcs.com · 8/10/2018 · Top Opioid Trends (Unmanaged) 2017 Trend 2016-2017 2017 Trend 2016-2017 Medication % of Total % of Total Scripts

12017 Drug Trends Series – Opioids & CompoundsFirst Script

2017 Drug Trends SeriesPart 3 Assessing opioids and compounds

Published August 2018


IntroductionThis 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 trend information for all drugs, which includes opioids and compounds; we also will break out the results for comparison into the managed and unmanaged views.

Understanding the DataThis Drug Trends 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 installment of our series includes the analysis of the managed, unmanaged, and aggregate views associated with opioid and compound trends. The managed data takes the traditional view (retail + mail-order) and adds prescriptions from our extended network. The unmanaged data represents the out-of-network prescriptions that are received and processed through medical bill review.

2 2017 Drug Trends Series – Opioids & Compounds First Script

2017 HighlightsAggregate Trends (Managed & Unmanaged)

Driven by decreasing utilization

Opioid Cost per Claim

17.3%

Compound Cost per Claim

65.1%

Opioid Utilization per Claim

13.2%

Compound Utilization per Claim

67.3%

Favorable declines in opioid utilization and cost were aided through patient and provider outreach programs, the use of risk-identification tools incorporating all sources of drug data, and key clinical programs focused on reducing opioid usage.

Overall Utilization Per Claim

8.0%

Overall Prescription Cost Per Claim

10.9%

Total Opioid Prescriptions 23.8%1.4% pts

Total Opioid Cost 23.4%1.7% pts

Total Compound Cost 3.0%4.7% pts

Total Compound Prescriptions 0.5%0.9% pts


2017 HighlightsOpioid Trends (Managed & Unmanaged)

Compound Trends (Managed & Unmanaged)

• Significantly older claim age (nearly 2.5 times the unmanaged)

• Higher severity of injuries • Larger percentage of claims with multiple fills

• Generally receive “one and done” single prescriptions

• Fills dispensed at a clinic, emergency room, doctor’s office, or hospital

Injured workers filling managed prescriptions

Managed

Injured workers filling unmanaged prescriptions

Unmanaged

3.7% decrease in opioid prescriptions for claims using opioids

0.9% increase in opioid prescriptions for claims using opioids

• Compound costs have steadily declined for 3 consecutive years and have fallen by more than half (1.4% points)

• Key states: NY, CA, TX, and PA each experienced a more than 50% reduction in the percentage of all claims utilizing compounds for the last 2 years

• Compound costs have fallen 15.7% points to 9.9% and are now at their lowest levels in the last 7 years

• 7 top-10 states, CA, PA, TX, IL, GA, NY, AZ, and CT, saw at least a 40% reduction in injured workers using compounds

Opioid trends have shown marked improvement for both the managed and unmanaged settings; however, differences in claim age and severity of injury continue to drive trends in opioid utilization, costs, and drug mix.

Cost per Script x Utilization = Cost per Claim Cost per Script x Utilization = Cost per Claim

Utilization and costs associated with compound medications fell significantly for both managed and unmanaged claims.

Utilization per Claim Cost per Claim

Cost per Script

Injured worker opioid utilization was 50.9% in 2017, down 3.4% points

9.8% 15.1%

5.9%

Utilization per Claim Cost per Claim

Cost per Script

20.7% 18.2%

3.1%

Number of injured workersusing compounds is 0.5%

Number of injured workers using compounds is 1.4%

0.4% pts 1.5% pts

Injured worker opioid utilization was 15.2% in 2017, down 4.1% points


Aggregate View – High-Impact Drug Classes

2016 Volume 2017 VolumeSpecialty Drugs

Compounds

Topicals

Opioids 25.3%

All Other Classes67.8%

1.3%

4.5%

1.1%

Specialty Drugs

Compounds

Topicals

Opioids 23.8%


4.8%0.5%

1.2%

Accounted for 23.8% of all prescriptions

Accounted for 0.5% of all prescriptions

Opioid Utilization

Compound Utilization

1.4% pts

0.9% pts

Opioids continue to trend favorably, accounting for a continually smaller share of overall cost and utilization.


Aggregate View – High-Impact Drug Classes

Specialty Drugs

Compounds3.0%


5.1%

Opioids 23.4%

Topicals 12.8%

Specialty Drugs


4.8%

Opioids 25.1%

Topicals 10.5%

Compounds7.7%

Accounted for 23.4% of all costs



Opioid Costs

Compound Costs

Topical Costs

1.7% pts

4.7% pts

2.3% pts

Coventry’s compound-management solution continues to drive down both the use of compounds and their related costs.

2016 Cost 2017 Cost


Aggregate Key TrendsCost and Utilization Changes (2016 to 2017)

Opioids

All ClassesTop 10 Classes

Anticonvulsants (4.3%) and topicals (8.6%) were the only classes with increasing costs as costs per script rose.

Among the top 10 drug classes, all experienced declining utilization and 8 had downward cost trends.

Opioid Cost per Claim

Total Cost per Claim

Compound Cost per Claim

Anticonvulsant Cost Per Script

Opioid Utilization per Claim

Total Utilization per Claim

Compound Utilization per Claim

Topicals Cost Per Script

17.3%

10.9%

65.1%

6.9%

13.2%

8.0%

67.3%

12.6%


OpioidsOpioids Represent:

23.8% of Total Aggregate Prescriptions23.4% of Total Aggregate Costs


Top Opioid Trends (Managed)

2017 Trend 2016-2017

Medication %ofTotal %ofTotal Scripts Cost Opioid Scripts Opioid Cost per Claim per Claim

Hydrocodone/acetaminophen 32.6% 9.9% -11.1% -15.1%

Oxycodone/acetaminophen 15.3% 19.6% -9.6% -10.2%

Tramadol 14.6% 4.0% -8.1% -14.1%

Oxycodone 10.4% 6.9% -3.9% -15.9%

OxyContin® 5.8% 21.3% -11.2% -12.7%

Top 5 opioids 78.6% 61.6% -9.4% -12.8%

All other opioids 21.4% 38.4% -11.1% -18.6%

All opioids -9.8% -15.1%

Top 5 Opioid Medications Ranked by Utilization

Opioid overdose antidotesWe saw shifts in usage from the more expensive Evzio®, which accounted for 15.8% of prescriptions filled, to Narcan®, or naloxone HCl, which represented 84.2%.

The number of injured workers using opioids dropped from

54.2% to 50.9%

Nucynta Nucynta ER

Nucynta® and Nucynta® ERNucynta and Nucynta ER continue to be the only two opioids among the top 20 that have experienced increasing trends in cost per claim. Both experienced Average Wholesale Price (AWP) inflation in the 13%-14% range.

The top 5 most utilized opioids accounted for 78.6% of utilization and 61.6% of cost for managed medications.

Cost per Claim

Utilization per Claim

13.9%

168.0%

Cost per Claim Cost per Claim8.1% 6.9%


Top Opioid Trends (Unmanaged)

2017 Trend 2016-2017 2017 Trend 2016-2017

Medication %ofTotal %ofTotal Scripts Cost Opioid Scripts Opioid Cost per Claim per Claim

Tramadol 29.3% 13.6% -12.5% -4.7%

Hydrocodone/ acetaminophen 26.6% 9.4% -29.0% -25.7%

Oxycodone/acetaminophen 9.9% 16.3% -20.4% -9.9%

Acetaminophen/codeine 8.5% 1.8% -16.8% -8.6%

Tramadol/acetaminophen 5.7% 0.8% -27.6% -60.9%

Top 5 opioids 80.0% 42.0% -21.2% -14.5%

All other opioids 20.0% 58.0% -18.4% -20.6%

All opioids -20.7% -18.2%

Top 5 Opioid Medications Ranked by Utilization

The number of injured workers using opioids dropped from

19.4% to 15.2%

The top 5 most utilized opioids accounted for 42.0% of cost for all unmanaged medications compared to 61.6% for managed.


Opioid Utilization by Claim Age

Managed Opioid Utilization by Claim Age*

Unmanaged Opioid Utilization by Claim Age*

* Opioid claims only

20162017

Managed opioid usage continues to decline but varies for unmanaged populations. Greater medical severity for claims filling managed opioid scripts drives the differential in utilization.

Opioid Utilization for Claims with Opioids

Average Claim Age

3.7%

5.8 years

Average Claim Age

Opioid Utilization for Claims with Opioids

2.5 years

0.9%

Only claims age 1 and 4 years showed declining utilization in 2017.

All claims age 1-10 years experienced a drop in opioid usage per claim.

Claims 2 years or less accountfor66.7% ofopioidscripts

Opi

oid

Scri

pts

per

Clai

m

20162017

Claims 2 years or less accountfor28.8% ofopioidscripts

Opi

oid

Scri

pts

per

Clai

m


Opioid Cost by Claim Age

Managed Opioid Cost by Claim Age*

Unmanaged Opioid Cost by Claim Age*

* Opioid claims only

20172016

20172016

Opioid Cost per Script

3.1%

Opioid Cost per Script

5.9%Claims age 1 – 9 years experienced a drop in opioid cost per script

Increases in the cost per prescription for older claims (8-10 years) has offset the decreases for younger claims (years 1 and 3).

Opioid cost per script continues to decline for the managed population but varies for the unmanaged.

Subsys®

Managed utilization (scripts per claim) of Subsys, which can cost as much as $24,000 per prescription, was a key factor in declining costs.

Utilization per Claim95.5%

Cost

per

Scr

ipt

Cost

per

Scr

ipt


CompoundsCompounds Represent:

0.5% of Total Aggregate Prescriptions3.0% of Total Aggregate Cost


Compound Trends

Injured Workers Filling at Least One Compound Prescription

Compound Cost2014

20162015

2017

2014

20162015

2017

Compound Cost (Managed) Compound Cost (Unmanaged)

Injured Workers Using Compounds (Managed)

Injured Workers Using Compounds(Unmanaged)

1.4% pts 15.7% pts

0.4% pts

1.5% pts

Cost per Compound(Managed)

Cost per Compound(Unmanaged)

17.8%

15.4%

Costs have steadily declined for 3 consecutive years and have fallen by more than half in 2017

Costs have fallen to their lowest level in 7 years

Dropped by just over half

Coventry’s out-of-network compound solution has been pivotal in decreasing costs.

The number of injured workers using compounds and the related costs continue to decline significantly.


Injured Workers Using Compounds in Top States Ranked by Total Drug Cost

Managed Compound Utilization

20162017

8 of the top 10 states experienced a reduction in injured workers using compounds

The percentage of injured workers using compounds increased in only 2 of the top 10 states

Other key states among the top 20 with significant reductions

4 states experienced a reduction of at least 50% in each of the last 2 years

Connecticut

Georgia

Virginia

Maryland

Colorado

7.1%

50.8%

2.0%

67.1%

58.2%

Top 10 States for Managed Compound Utilization


Injured Workers Using Compounds in Top States Ranked by Total Drug CostUnmanaged Compound Utilization

20162017

9 of the top 10 states experienced a decrease in injured workers using compounds

7 of the top 10 states (CA, PA, TX, IL, GA, NY, AZ) declined by at least 40%

Only 1 state among the top 10 had an increase in compound use

Florida5.6%

Top 10 States for Unmanaged Compound Utilization


Compound Costs in Top States Ranked by Total Drug CostManaged Compound Cost

20162017

The top 10 states accounted for 50.3% of all compound costs

Compound costs for 8 of the top 10 states dropped at least 50% with Texas and California experiencing the biggest decreases

Among the top 20 states, compounds in Louisiana (4.8%) represented the highest percentage of cost

Texas

California89.4%

86.5%

Top 10 States for Managed Compound Cost


Compound Costs in Top States Ranked by Total Drug CostUnmanaged Compound Cost

20162017

The top10 states accounted for 78.4% of all compound cost with FL, CA, PA, and IL representing 65.6%

Compound costs for 6 of the top 10 states dropped at least 50% with Texas and California experiencing the biggest decreases

Texas experienced the greatest reduction in compound costs

85.4%

Top 10 States for Unmanaged Compound Cost


Overall, 2017 showed favorable trends for two areas of significant impact in the workers’ comp space: Both opioids and compounds declined in utilization and cost. This shift marks major strides in societal awareness, regulatory and governance efforts, and clinical program improvement for managing pharmacy benefits.

• As focus areas such as opioids and compounds experience decreases in use, it is important to monitor other cost drivers that may start to increase as prescribers look for alternatives. For example, the topical drug category is trending up in cost and utilization as are non-opioid pain management drugs. Deploying tactics to anticipate and determine appropriateness of such therapies will be critical.

• Understanding the differences in injured worker populations filling in both the managed and unmanaged spaces can help us to build programs that best fit the needs of those individuals. This knowledge also provides guardrails for what to watch and helps us drive toward best outcomes.

• Opioids in the managed space show more favorable improvements in cost and utilization trends, highlighting the importance of driving more scripts toward in-network sources for better management through safety and clinical controls.

• Risk identification tools remain essential with opioid use, and the appropriateness of interventions such as overdose reversal agents (i.e. naloxone) in alignment with treatment guidelines such as those put forth by the CDC should be considered. Formulary controls and utilization review programs can assist in continuing to incite cost-effective and medically appropriate naloxone options.

• While compound cost and utilization is down, it is important to continue to monitor this category through formulary controls, utilization management strategies, and staying up to date with regulatory changes and juris-specific rules. Insight into transactions from all sources, whether in- or out-of-network, is important to this end.

In our next installment of the Drug Trends Series, we will consider future trends, including specialty drugs and drug formularies.

Conclusion & Recommendations


Coventryistheleadingproviderofcareandcostmanagementsolutionsforworkers'comp,disabilityandautoinsurancecarriers,third-partyadministrators,andself-insuredemployers.Wedesignbest-in-classproductsandservicestohelpourpartnersreturninjuredworkerstowork,toplay,andtolifeasquicklyandascosteffectivelyaspossible.Weaccomplishthisbydevelopingandmaintainingconsultativepartnershipswithourclientsandstakeholders,builtonafoundationoftrustthatsupportstheclaimsmanagementprocess.

FirstScriptisthePharmacyBenefitandDrugUtilizationManagementProgramofferedaspartoftheCoventrysuiteofproducts.FirstScriptoffersanend-to-endprogramdesignedspecificallyforworkers’compensation.Werealizethatgetting100%ofprescriptionsintothenetworkisn’ttheendgame;it’swhatyoudowiththoseprescriptionsthatmatters.Earlytriageofeachinjuredworkerensuresthatinjuredworkersknowhowandwheretogetaprescriptionfilled,andpermitsustointerveneaggressivelyonpotentiallyproblematicopioidutilizationattheearliestpointpossible.Throughintegrationwithourbillreviewandcasemanagementprograms,wearepositionedtocaptureallprescriptionactivityforutilizationandtotalpharmacyriskmanagement,ensuringthatwemanagenotonlytheFirstScript,butEveryScript.

3200 Highland Ave. • Downers Grove, IL • 60515 • 800.243.2336 • www.coventrywcs.com©2018CoventryHealthCareWorkersCompensation,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 Workers’ Comp Services accepts no liability for the content of this distribution, or for the consequences of any actions taken on the basis of the information provided.

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Drug Trends Series Part Three 2017 - coventrywcs.com · 8/10/2018 · Top Opioid Trends (Unmanaged) 2017 Trend 2016-2017 2017 Trend 2016-2017 Medication % of Total % of Total Scripts