Opioid Prescriptions See Largest Annual Drop in 25 Years

Megan Brooks

April 19, 2018

The volume of prescription opioids dispensed by US doctors dropped 12% last year, marking the largest annual decline in 25 years, according to a new report released today.

But, at the same time, overall use of medications and list prices continued to rise last year while out-of-pocket costs for many patients went down due to generics and manufacturer coupons, the report shows.

In 2017, physicians dispensed 23.3 billion fewer morphine milligram equivalents (MMEs) to patients. In addition to MMEs, actual dispensed opioid prescriptions declined 10.2% and the percentage of patients receiving high doses of opioids (≥ 90 MMEs/day) declined by 16.1%.

The report, Medicine Use and Spending in the U.S. A Review of 2017 and Outlook to 2022, was prepared by the IQVIA Institute for Human Data Science, formerly IMS Health and Quintiles.

Rising Barriers a Factor?

The report notes that the volume of prescription opioids dispensed increased annually since 1992, peaked in 2011, and then declined by an average 4% per year from 2012 through 2016 in all 50 states.

Factors driving the decline in opioid prescriptions include major clinical guideline shifts and payer reimbursement controls as well as regulatory and legislative restrictions, the report shows.

"It's probably fair to say some prescribers don't change their habits without significant bureaucratic and administrative burdens, so the rising barriers to opioid prescribing in a lot of states are having an impact," Michael Kleinrock, research director, IQVIA Institute for Human Data Science, told Medscape Medical News.

"The US opioid epidemic is one of the most challenging public health crises we face as a nation, and our latest report provides novel insights and evidence as part of that ongoing societal discussion," Murray Aitken, IQVIA senior vice president and executive director, IQVIA Institute for Human Data Science, said in a news release.

"Our research and analytics revealed that 2017 saw new therapy starts for prescription opioids in pain management decline nearly 8%, with a near doubling of Medication-Assisted Therapies (MAT) for opioid use dependence to 82,000 prescriptions per month," he said.

"This suggests that healthcare professionals are prescribing opioids less often for pain treatment, but they are actively prescribing MATs to address opioid addiction. These opioid details, as well as more general evidence-based finding in this study, have not been widely reported until now," Aitken noted.

Patients Using More Meds, Out-of-Pocket Costs Down

Patient use of medicines continued to rise in 2017, with a significant increase in 90-day prescriptions for the treatment of chronic conditions. Hypertension is the largest therapy area by drug volume, and it affects nearly one-third of Americans. New hypertension guidelines that include lower thresholds for hypertension diagnosis could further increase the volume of prescriptions for antihypertensive medications, according to the institute release.

The report also notes that drug list prices at pharmacies rose by 58% during the past 5 years, but final out-of-pocket costs for patients declined 17% as increasing uptake of generics and greater use of coupons lowered patient costs. Almost 31% of prescriptions were dispensed at no patient out-of-pocket cost; however, patients paid $500 or more out-of-pocket when filling 3.4 million prescriptions in 2017.

"This remains a major issue for those patients filling those prescriptions," Aitken said during a press briefing. "The use of coupons and manufacturer buy-downs is increasing as a way to off-set what would otherwise be increasing costs borne by patients. These have become a more routine part of the payment landscape." However, "abandonment rates remain high," Aitken said, noting that about 21% of all brands are not picked up at the pharmacy.

According to the report, 42 new drugs were launched in 2017, more than double the number launched in 2016. Half of these new drugs were orphan drugs for rare diseases and 14 were for cancer, 19 had breakthrough therapy designation from the US Food and Drug Administration (FDA), 18 included patient-reported outcomes as part of their FDA-approved label, and 10 had predictive biomarkers.

The report also shows that spending on all US medicines increased just 0.6% to $324 billion on a net basis due to greater uptake of generics, larger manufacturer discounts, and increasing coupon use. "The overall medicine spending is flatter than everybody feared," Kleinrock said.

The report projects a modest overall increase of 2% to 5% in net spending on drugs in the next 5 years, with 1% to 4% growth in retail and mail-order prescription drugs. That is expected to drive overall medicine spending in the United States to an estimated range of $550 to $600 billion by 2022, or $380 to $410 billion on a net basis. This growth, driven primarily by the large number of new medicines, many of which will be specialty and orphan drugs, will be offset by the impact of losses of brand exclusivity.

The report was produced independently as a public service, according to the institute, without industry or government funding.

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