Often lying off the radar screen of many insured populations is the high number of prescriptions for Opoid analgesics (or narcotic analgesics). These drugs are prescribed for pain relief for a wide range of conditions and the potential for abuse of these medications has grown over the past several years.
High utilization patterns of these prescription drugs do not always attract attention because compared to other classes of medications, these drugs are relatively inexpensive. As seen in Figures 1 and 2 below, based on a 50,000 patient commercial dataset, when sorted by total allowed charges, Opoid analgesics rank 13 in terms of highest total cost, but when we sort by number of prescriptions, this therapeutic class jumps in rank to number 2.
There are several methods for analyzing utilization of drug classes to identify opportunities for intervention. For a broad class of drugs, such as opoid analgesics it is useful to drill further into the therapeutic classes. In table 1, we see that the highest number of prescriptions were filled for Hydrocodone Combinations (including drugs like Vicodin), followed by Opioid Agonists (a category of very strong analgesics including morphine and Oxycontin) and Codeine Combinations (including drugs like Percocet and Percodan.)
Analysts may want to analyze utilization by network, or geographic areas to determine if specific markets have higher utilization rates compared to others. Table 2 displays prescription utilization by plan, revealing that Plan 3 had the highest utilization rate for these drugs.
Identifying possible cases of abuse typically involves drilling down to the provider or patient level. Table 3 illustrates an example analyzing utilization by PCP.
A complete analysis would include additional reports to better understand the prescribing physician specialties, the types of conditions they treat (chronic use of pain medications for periods of time may be appropriate for some conditions like cancer), days supplied and refill rates. At the patient level, it may also be important to quantify how many different providers have prescribed these drugs, as one physician is not likely to know what other physicians have prescribed for that patient, if the patient has not disclosed that information.
Analgesics are not the only class of drugs that have the potential for abuse. Generic Engineering & Biotechnology News recently “put together a list of 14 top abused prescription drugs , as listed by CDC FDA and nongovernment nonprofit sources on public websites.” Their list is as follows (listed by drug brand name).
- Adderal XR
- Opana ER
- Xanax XR