Medicare Favors Cheaper Opioids Over Ones with Abuse-Deterrent Properties

OpioidsMedicare Part D plan coverage for abuse-deterrent, brand name opioids has declined from 2012 to 2015.

While Part D coverage rates for all prescription opioids decreased 10 percentage points during that time, coverage for branded OxyContin, which had received abuse-deterrent labeling, fell even more (28 percentage points), according to a report from Avalere.

There are currently four branded drugs with abuse-deterrent labeling and no generic opioids with abuse-deterrent labeling.

The Opioid Generic Dilemma

“While prescription opioid abuse continues to be a priority for public health experts and lawmakers, coverage for these products by Part D plans is limited and plans are increasingly favoring lower-cost generic products on their formularies,” Caroline Pearson, senior vice president at Avalere, said in a post on Avalere’s website. “Policymakers seeking to limit opioid abuse will have to balance the desire for greater access to abuse-deterrent opioids with the increased costs of such medications to public programs and private payers.”

The Elderly are Most Affected

Prescription opioid abuse among senior citizens has been particularly concerning as misuse of prescription pain relievers among individuals age 65 and older can was estimated in 2013 to have increased threefold from a decade prior, according to data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health.

Avalere’s Report

Avalere’s analysis of opioid coverage and utilization management in Part D found that a quarter of plans require prior authorization for OxyContin in 2015. Generic Oxycodone, which has no abuse-deterrent properties, is covered by all Part D plans and faces lower levels of utilization management. In addition, although the FDA decided not to grant Opana ER abuse-deterrent labeling, it still has a higher coverage rate than OxyContin.

The Avalere report surmises that the analysis suggests plans favor covering lower-cost generic alternatives rather than opioids with abuse-deterrent labeling.

“As policymakers continue to consider options to combat opioid abuse, it will be important for them to consider how to ensure patient access, including access to new innovations that might help limit potential abuse, while balancing this imperative with cost challenges,” the report concludes.

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