Stark County Safety Council Presentation: Opioid & Anti-Anxiety … · 2015-06-24 · Stark County...

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


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


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.


The Pharmacy Tools


Relatedness Drugs &

Prior Authorization Requirements

Drug Utilization Reviews

Formulary


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%)


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


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


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


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


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


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


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


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


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


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


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


Patients with total


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


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


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


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


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


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


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


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


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


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


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


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


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!

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Stark County Safety Council Presentation: Opioid & Anti-Anxiety … · 2015-06-24 · Stark County...

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