Impact of Opioid Abuse on Managed Care

Drug overdose results in countless deaths every year in the United States, most commonly because of abuse of prescription opioid pain relievers, benzodiazepines, and stimulants. In a multi-state report from the CDC and FDA, 8 states submitted 2013 data for the CDC Morbidity and Mortality Weekly Report Surveillance Summary.

The study results showed that prescribing standards varied significantly among states and revealed the need for improved prescribing practices for opioids, which are prescribed twice as frequently as stimulants or benzodiazepines. Despite the risk for adverse drug interactions, patients who received opioid prescriptions also frequently received benzodiazepines.

“A more comprehensive approach is needed to address the prescription opioid overdose epidemic, including guidance to providers on the risks and benefits of these medications,” said Debra Houry, MD, MPH, director, CDC, Center for Injury Prevention and Control.

How Opioid Abuse Impacts Managed Care

With the increase in opioid abuse and opioid-related drug overdoses, the burden on the country’s economy also rises, including a substantial financial burden on managed care organizations (MCOs). About 10% of US health care spending is allotted for prescription drug costs. In 1990, prescription drug costs were about $40 billion annually; 56% was paid by consumers and 26% by private insurances, but those numbers severely changed in 2006 when the costs rose to $216.7 billion annually, with 22% paid by consumers and 44% by private insurers. The government share of prescription drug costs also rose during that time from 18% to 34%.

Two recent studies delved into the economic and health impact of opioids in patients with private or Medicaid insurance. The studies discovered that the prevalence of opioid abuse was much higher in Medicaid beneficiaries than in private insurance holders. Annual medical costs were $6650 to $14,054 higher for opioid abusers than for non-abusers for both Medicaid and private insurance recipients, as opioid abuse is associated with comorbidities that increase direct medical costs and societal burden.—Amanda Harvey

References

1. Centers for Disease Control and Prevention. Clues to opiod abuse from state prescription drug monitoring programs. Updated October 15, 2015. Accessed February 28, 2016.
2. Birnbaum HG, White AG. Opiod abuse: the managed care perspective. Analysis Group, Inc. Published June 2011. Accessed February 2016.
3. Katz NP, Birnbaum H, Brennan MJ, et al. Prescription opioid abuse: challenges and opportunities for payers. Am J Manag Care. 2013;19(4):295-302.
4. Ghate SR, Haroutiunian S, Winslow R, McAdam-Marx C. Cost and comorbidities associated with opioid abuse in managed care and Medicaid patients in the United Stated: a comparison of two recently published studies. J Pain Palliat Care Pharmacother. 2010;24(3):251-258.
5. Pahon E. FDA moves quickly to approve easy-to-use nasal spray to treat opioid overdose. Accessed February 28, 2016.