Finally, Some Good News About Opioids
By Joan E. Collier
Texas is making some big boasts about the success of its workers’ compensation pharmacy closed formulary.
When the state adopted the system in 2010, new injury claims became subject to the pharmacy closed formulary beginning Sept. 1, 2011; legacy claims became subject to the formulary two years later, on Sept. 1, 2013.
The formulary requires pre-authorization for investigational and experimental drugs, any non-FDA approved drugs, and, most importantly, compounds that include N-drugs and all medications with an “N" status under the Official Disability Guidelines—including many opioids.
It is the N-drug statistics in a new report from the Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, that I want to draw your attention to. The report, says that, in a review of pharmacy services for all claims (new and legacy claims by service year):
- Between FSY 2011 (pre-formulary) and FSY 2014 (post-formulary for legacy claims), the number of injured employees receiving N-drugs fell by 83 percent. Those receiving Other drugs fell by 12 percent.
- The number of N-drug prescriptions fell by 85 percent. Other drug prescriptions fell by 14 percent.
- N-drug costs fell by 80 percent while Other drug costs fell by 5 percent.
- The number of N-drug prescriptions decreased by 80+ percent in all drug groups. Costs fell by 70+ percent in all drug groups. Prescriptions and costs of Other drugs decreased by between 5 percent and 25 percent.
- Generic drug utilization rates for N-drugs increased from 58 percent to 71 percent of the prescriptions. Generics accounted for 23 percent of the cost pre-formulary, and 35 percent post-formulary.
- For Other drugs, generic utilization in prescription increased from 83 percent to 89 percent. Cost shares increased from 62 percent to 66 percent.
- The number of claims receiving N-drug opioids with 90+ MMEs/day decreased from almost 15,000 in 2009 to less than 500 in 2015.
- No N-drugs are in the top ten most prescribed drugs.
Wow. As impressive as the dramatic drop in opioid costs in terms of dollars per pill is, what we really care about is the drop in opioids usage, and the attendant benefit to society as a whole. In that regard, the usage decreases cited in the report are even more impressive. And, there is no indication that Other drugs are being substituted for N-drugs.
Here’s why, in case anyone needs reminded of our epidemic:
- According to the CDC, since 2000, the rate of deaths from drug overdoses has increased 137 percent, including a 200 percent increase in the rate of overdose deaths involving opioids.
- The American Society of Addictive Medicine says that of the 21.5 million Americans 12 or older who had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers.
- The U.S. Department of Health and Human Services calculates $5 billion in health and social costs related to prescription opioid abuse each year.
- Addictions.com reports that an estimated 80 percent of prescription painkillers are prescribed by 20 percent of prescribers (further validation of the old 80/20 rule).
We have so much bad news about the disastrous effects of opioid use and abuse in this country, that it’s a happy day when we can spread some good news. Congrats to Texas, and to all the other states, agencies, and workers’ compensation systems fighting the good fight.
(Read more Work Comp Nation blogs here.)
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