Studies show cost and use of opioid dependence treatment are increasing, spurring the need for care management programs

ST. PAUL, Minn., Sept. 30, 2014 /PRNewswire/ -- In 2011, approximately 5.1 million people in the United States abused prescription pain relievers (e.g. opioids).¹ Clinical treatments for opioid dependence include detoxification or maintenance treatment, which entails the use of buprenorphine, buprenorphine/naloxone, naltrexone or methadone. The patterns and costs of these treatments are important when developing and improving care management programs, according to two studies by pharmacy benefit manager Prime Therapeutics LLC (Prime).

Cost trends of opioid dependence treatment

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.

Prime found the following:

• Overall, buprenorphine total paid per member per month (PMPM) increased by 38 percent.
• The buprenorphine and naloxone sublingual film drove the increase in overall PMPM, increasing by 134 percent from $0.130 in 2011 to $0.304 in 2013.
• The two highest buprenorphine expense states were located in the south and had PMPMs of $0.727, up 53 percent from 2011, and $0.557, up 22 percent from 2011. Average costs in the other 10 states analyzed ranged from $0.144 to $0.469 during 2013.

Buprenorphine use and member characteristics

Prime researched buprenorphine patterns, such as the length of time used and simultaneous opioid use. The study included all commercially insured members in one southern Blue Cross and Blue Shield plan who had a claim for a product with buprenorphine during 2012 and 2013.

The study identified 5,564 members with one or more buprenorphine claims between Jan. 1, 2012, through Dec. 31, 2013. The average length of buprenorphine therapy was approximately nine months. The median number of claims was nine. Five percent of members had 60 or more days supply of opioid during their buprenorphine treatment and one in every seven members had three or more prescribers for the buprenorphine.

"Understanding the patterns and costs associated to opioid dependence treatments is important when developing and improving care management programs for members," said Cathy Starner, PharmD, senior health outcomes researcher at Prime. "This knowledge can help ensure successful therapy for our members and prevent waste."

Prime is presenting its findings at the Academy of Managed Care 2014 Nexus conference in Boston on Oct. 9, 2014.

¹ Administration SAMHSA. Results from the 2011 national survey of drug use and health: national findings. Rockville, MD: 2013. http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHFR/NSDUHmhfr2011.htm Accessed August 15, 2014.

About Prime Therapeutics

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

For more information, visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.

SOURCE Prime Therapeutics LLC