stark county safety council presentation: opioid & anti-anxiety … · 2015-06-24 · stark...
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Stark County Safety Council Presentation:Opioid & Anti-Anxiety Medication Use
Among Ohio’s Injured Workers
John Hanna, R.Ph.BWC, Pharmacy Director
6/24/2015 BWC Pharmacy Program Overview 1
June 11, 2015
Discussion Overview The BWC Pharmacy Program & Mission How the Mission is Accomplished Impact on Drug Utilization - 2014 Impact on Opioids – 2010 - 2014 Mission Focus Going Forward
6/24/2015 BWC Pharmacy Program Overview 2
The BWC Pharmacy Program2014 vs 2010
• 50,022 Injured Workers received an Rx (-26%)• 990,369 Prescriptions covered (-36%)• $113.4M total prescription cost (-16%)
– Average Unit cost/Rx = $114.52 (+8.2%)– Average Rx Cost/Injured Worker=$2,185.86 (+13.7%)
• Generic Dispensing Rate = 83.4% (+4.8% vs ‘13)– Each 1% Increase in GDR = $3.35M cost savings
6/24/2015 BWC Pharmacy Program Overview 3
The Pharmacy Program Mission• Manage drug utilization to ensure
coverage for necessary medications to allow proper care of injured workers in a fiscally responsible manner.
6/24/2015 BWC Pharmacy Program Overview 4
The Pharmacy Tools
6/24/2015 BWC Pharmacy Program Overview 5
Relatedness Drugs &
Prior Authorization Requirements
Drug Utilization Reviews
Formulary
6/24/2015 BWC Pharmacy Program Overview 6
Formulary Impact: Drug Utilization
2014 vs 2010 o24% fewer Injured workers received opioids
o Opioid prescriptions (-38%) o 48% fewer Injured workers received muscle relaxants
o Muscle relaxant prescriptions (-72%)o 79% fewer injured workers received anti-ulcer drugs
o Anti-Ulcer prescriptions (-83%)
6/24/2015 BWC Pharmacy Program Overview 7
Formulary Impact: Drug Costs
2014 vs 2010Total drug costs: -$22.8 million (-16.8%)o Opioids: -$19.9 million (-36%)o Muscle relaxants: -$2.8 million (-78%)o Anti-ulcer drugs: -$6.4 million (-95%)
Automated Rx Edits: Relatedness List Drugs
6/24/2015 BWC Pharmacy Program Overview 8
In 2014 Automated Edits Applied in the pharmacy on all RxsStopped initial coverage of 235,000 Rxs
Relatedness List Edits May require a PA Apply to 373 of 405 drug classes Matches drug indication & allowed conditions
3900 PAs processed by the PBM Pharmacists 4400 PAs processed by BWC staff
6/24/2015 BWC Pharmacy Program Overview 9
Automated Rx Edits: Formulary & Special Claim Edits
Rxs for certain formulary drugs require a PASR Opioids, Muscle Relaxants, TestosteroneSome require an allowance – Fentora, Lidoderm,Suboxone
Special Claims Edits Medical Only Claims All require a PA after 60days from DOI
Claims with no prescriptions for 270 days Require a PA for any prescription
6/24/2015 BWC Pharmacy Program Overview 10
Drug Utilization Reviews
2014 BWC-MCO Workgroup Recommendation Transition this activity to the MCOsDUR workgroup began work in June New process developed
Pilot of new process began in November 2014 Transition to all MCO’s 7/1/2014
4192 DURs performed by BWC/MCOs in 2010 2664 DURs performed by MCOs in 2014
6/24/2015 BWC Pharmacy Program Overview 11
Injured Workers Receiving Medications 2001 to 2014
56,889
63,60265,881
68,82566,611
63,93760,923
55,11551,712 49,957
47,68043,140
39,42734,458
98,352 97,337 95,539 97,286
91,37687,178
82,331
75,109
69,85867,406 65,338
60,82156,398
50,211
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
110,000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
All injured workers receiving prescriptions
Injured workers receiving opioids
6/24/2015 BWC Pharmacy Program Overview 12
Injured Workers Receiving Opioids 2001 - 2014
58%
65%
69%
71%
73% 73% 74% 73% 74% 74%73%
71%70%
69%
50%
55%
60%
65%
70%
75%
80%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
6/24/2015 BWC Pharmacy Program Overview 13
Opioid Utilization 2001 - 2014
565543
580611
644665
683
778815 825 813 801
782 785
250
350
450
550
650
750
850
950
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Opioid doses per injured worker receiving opioids
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Opioid Utilization 2001 - 2014
9926
9037
9834
10736 11026 1124511663
13207
1466315198 15054 14770
1400313609
4500
6500
8500
10500
12500
14500
16500
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Annual opiate load per injured worker receiving opioids (Mg MED/IW)
BWC Opiate Utilization 2010 vs. 2014
6/24/2015 BWC Pharmacy Program Overview 15
o BWC’s opiate dependency guideline: 60mg MED/Day for 60 days
o In fourth quarter 2010• 8,689 injured workers received this dose of opiates
• 13% of all injured workers receiving medications in 2010 were opiate dependent.
• 17% of injured workers receiving opioids
o In fourth quarter 2014:
• 5,469 injured workers met it;• 11% of all injured workers receiving medications.• 16% of injured workers receiving opioids
6/24/2015 BWC Pharmacy Program Overview 16
Top 10 Highest Opiate Prescribers 2010 vs. 2014
High dose opiate prescribers - 4th quarter 2010
Prescriber
Patients with total
Mg MED/day
> 399
Patients with total
Mg MED/day 400 - 799
Patients with total
Mg MED/day 800 - 999
Patients with total
Mg MED/day
> 999
Dr. A 36 15 4 17
Dr. B 24 14 4 6
Dr. C 17 14 2 1
Dr. D* 13 11 2
Dr. E* 12 6 1 5
Dr. F 12 10 2
Dr. J* 11 5 5 1
Dr. H 9 9
Dr. I 8 7 1
Dr. J* 8 8
High dose opiate prescribers - 4th quarter 2014
Prescriber
Patients with total
Mg MED/day
> 399
Patients with total
Mg MED/day 400 - 799
Patients with total
Mg MED/day 800 - 999
Patients with total
Mg MED/day
> 999
Dr. B 13 8 4 1
Dr. K** 11 9 1 1
Dr. L 11 11
Dr. M 7 6 1
Dr. N 6 4 1 1
Dr. O 6 6
Dr. P 6 5 1
Dr. Q 6 5 1
Dr. A** 5 1 3 1
Dr. W 5 5
6/24/2015 BWC Pharmacy Program Overview 17
Acute to Chronic Opioid Use In New Claims Date of Injury (DOI) 2011 vs. 2013
IWs with DOIs in 2011 TotalsPercent of 2011 total IWs with DOIs in 2013 Totals
Percent of 2013 total
2011 vs. 2013 Percent change
IWs that received RX prior to July 2012 8,448
IWs that received RX Prior to 7-2014 6,001 -29%
IWs with "acute" opiate script (RX with 28 days) 4,754 56%
IWs with acute opiate script ( RX with 28 days) 3,452 58% -27%
IWs with ongoing opiate script (RX after 84 days) 4,483 53%
IWs with ongoing opiate script (RX after 84 days) 2,755 46% -39%
IWs with acute and ongoing opiate Rx after July 2012 1,531 18%
IWs with acute and ongoingopiate Rx after July 2014 863 14% -44%
BWC Opioids 2010 – 2014
6/24/2015 BWC Pharmacy Program Overview 18
YearTotal
prescribersTotal
patientsTotal
prescriptionsTotal drug quantity
Average quantity per Rx
Average MED per Rx
January 2010 - June 2010 8,543 37,516 218,197 18,277,457 84 68
July 2010 - December 2010 8,720 36,776 216,005 18,180,934 84 70
January 2011 - June 2011 8,132 35,112 204,746 17,228,114 84 73
July 2011 - December 2011 7,980 33,488 194,240 16,192,431 83 71
January 2012 - June 2012 7,563 31,694 179,583 15,272,207 85 71
July 2012 - December 2012 7,303 29,571 166,599 14,334,947 86 71
January 2013 - June 2013 6,991 28,572 156,887 13,518,868 86 69
July 2013 - December 2013 6,880 26,836 150,790 12,878,079 85 66
January 2014 - June 2014 6,592 25,749 141,951 12,186,292 86 64
July 2014 - December 2014 6,102 23,517 128,652 11,161,943 87 62
Total Ohio Opioids 2010 - 2014
6/24/2015 BWC Pharmacy Program Overview 19
YearTotal
prescribersTotal
patients
All Ohio Average
quantity per Rx
All Ohio Average
MED per RxBWC Average quantity per Rx
BWC Average MED per Rx
January 2010 - June 2010 50,256 1,865,244 63 56 84 68
July 2010 - December 2010 53,500 1,908,139 64 55 84 70
January 2011 - June 2011 58,148 1,889,141 64 51 84 73
July 2011 - December 2011 80,778 1,954,246 64 52 83 71
January 2012 - June 2012 80,983 1,978,083 65 52 85 71
July 2012 - December 2012 89,671 2,088,386 66 52 86 71
January 2013 - June 2013 92,862 1,923,155 66 51 86 69
July 2013 - December 2013 89,852 1,918,102 65 51 85 66
January 2014 - June 2014 82,769 1,882,892 64 51 86 64Source: Oho Board of
Pharmacy 2014 Annual OARRS Report
6/24/2015 BWC Pharmacy Program Overview 20
2011 vs 2014 Opioid Dependence (Injured Workers Above 60mg MED/Day)
1340
3187
2797
601
46 58
1136
2456
1598
243
20 160
500
1000
1500
2000
2500
3000
3500
60 - 79 mg MED 80 - 159 mg MED 160 - 399 mg MED 400 - 799 mg MED 800 - 999 mg MED > 1000 mg MED
2011 Opiate Dependent IWs 2014 Opiate Dependent IWs
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Opioid Use By Age of Injured Worker 2011 -2014
14
2523
5803
22259
5161
1629 886
2741
16289
4752
163
0
5000
10000
15000
20000
25000
10 - 19 20 - 34 35 - 44 45 - 64 65 - 84 85 - 95
2010 IW's per Age Band 2014 IW's per Age Band
Age ranges201116 – 95201417 - 95
6/24/2015 BWC Pharmacy Program Overview 22
Percentage of Opioid Use By Injured Worker Age Q4-2011 vs Q4-2014
0.04%
7%
16%
62%
14%
0.5%0.04% 4%
11%
66%
19%
1%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
10 - 19 20 - 34 35 - 44 45 - 64 65 - 84 85 - 95
2010 Age Band Pct of Total 2014 Age Band Pct of Total
Anti-Anxiety Agent Utilization 2010 - 2014
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10,350 9,912 9,073 8,314 7,800
67,40665,338
60,82156,398
50,211
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
2010 2011 2012 2013 2014
Injued Workers Receiving Benzodiazepines
6/24/2015 BWC Pharmacy Program Overview 24
15.4% 15.2% 14.9% 14.7%15.5%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
2010 2011 2012 2013 2014
Percent of IW's with Anti-anxiety Drugs
Anti-Anxiety Agent Utilization 2010 - 2014
6/24/2015 BWC Pharmacy Program Overview 25
1143
589
1932 1931
919
305
440
500
1000
1500
2000
2500
10 - 19 20 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 - 95
2014 Benzodiazepine Use By IW Ages
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0.65
15 15
13
16
14
10
6
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
10 - 19 20 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 - 95
Avg Daily Anti-Anxiety Drug Load (mg/IW)
Opiates and the Injured Worker
6/24/2015 BWC Pharmacy Program Overview 27
Five Ohioans die every day due to unintentional drug poisoning.
Between 2006 to 2013, on average, one injured worker died every week due to drug overdose.
Ove half of the injured worker drug overdose deaths in 2013 also involved a benzodiazepine
An injured worker was over three times more likely to die from drugs than the general population.http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/injury%20prevention/2012%20overdose%20data/1finalCB_2012_Bullets%20for%20reporters%20on%20drug%20related%20poisoning.ashx
6/24/2015 BWC Pharmacy Program Overview 28
Going Forwardo Implement an automated process to
identify high risk medication regimens and trigger direct clinical staff contact with the prescriber.
o Establish an opioid prescribing rule based on best clinical practices for both prescribing as well as discontinuing these drugs.
o Initiate a retail pharmacy based medication therapy management program to coordinate medications in high risk claims.
Thank You!
Questions?