In this segment, moderator J David Haddox, DDS, MD, and panelists Jeffrey Dunn, PharmD, MBA; Peggy Johnson; and Burton VanderLaan, MD, FACP, discuss the role of abuse-deterrent formulations as one component of a multifaceted strategy to address nonmedical use of opioids.
Although abuse-deterrent formulations may help address the problem of nonmedical opioid use, Jeffrey Dunn, PharmD, MBA notes that there are some challenges from a payer perspective. For example, abuse-deterrent formulations address abuse by manipulation; however, the majority of opioid misuse involves taking more than has been prescribed or taking someone else’s medication—routes of abuse not addressed by abuse-deterrent formulations. Also, hydrocodone is a high-volume drug in most systems, and the budget impact of branded abuse-deterrent formulations on payers and employers would be a concern.
It is important to identify those individuals for whom an abuse-deterrent formulation would be appropriate, remarks Burton VanderLaan, MD, FACP. However, even if a patient is prescribed an abuse-deterrent formulation, they may still have access to generic non—abuse-deterrent formulations via other means (eg, relative or friend), Dunn adds. Abuse-deterrent formulations are one part of a multifaceted approach, remarks Peggy Johnson. VanderLaan concurs, adding that when opioids with abuse-deterrent properties are prescribed, education and monitoring are still important.
When a patient is revealed to be misusing prescription medication, Haddox considers this an education moment for the individual and their family. The reasons why the patient is not following the treatment program should be explored. The patient may have a substance use disorder or may be trafficking. The key is to identify the problem and address it.
With regard to factors that payers take into consideration when considering whether to cover a particular abuse-deterrent opioid, Dunn and VanderLaan comment that comparative efficacy, comparative safety, and comparative cost are taken into account. There is an unmet need for outcomes data regarding the real-world effectiveness and cost offsets related to coverage of abuse-deterrent formulations; for example, reduction in emergency department visits and medical expenses.
Some payers may require that abuse-deterrent formulations be prescribed by certain specialists. However, Dunn remarks that primary care physicians should be prescribing abuse-deterrent formulations, as these physicians don’t have the same resources as pain management specialists. Also, by the time a patient sees a pain management specialist, there may already be an abuse problem. “Primary care is a good place to avoid the problem rather than create the problem,” states Dunn.