Update From Express Scripts Investigates Opioid Use by Medicaid Members

The update follows an earlier report from Express Scripts on the nation's crisis, which revealed that women are using more opioids than men.

Nearly one-fourth of Medicaid members filled an opioid prescription and nearly one-third of them took opioids for more than 30 days in 2015, according to a new report from Express Scripts. The pharmacy benefits manager offered an update Wednesday to its 2014 report on the nation’s opioid crisis.

The report, A Nation in Pain: Focus on Medicaid, investigated opioid use and the influence of gender and age among Medicaid members. The report considers the utilization of 3.1 million Medicaid members, in 14 states, between January 1 and December 31, 2015.

Express Scripts’ 2014 report, A Nation in Pain, discovered a greater prevalence of opioid use among women. This new report on Medicaid members shows that 25% of women in the Medicaid population who filled any prescription during 2015 filled at least 1 for an opioid, while 20% of the men in the Medicaid population who filled at least 1 prescription obtained at least 1 for an opioid.

Age also plays a role in opioid use among Medicaid members; 31.1% of opioid users were between the ages of 45 and 64, followed by 26% who are between 20 and 44 years old. This aligns with data released this week from the Agency for Healthcare Research and Quality, which found that while the 20-44 age group had more hospitalizations overall from 2004 to 2014, the 45-64 age group had recently overtaken younger opioid users in hospital admissions.

“Opioids use affects people of all ages and across all socioeconomic backgrounds. However, Medicaid members are 10 times more likely to suffer from addiction and substance abuse than the general population,” Express Scripts’ spokesman Brian Henry said. “Even more alarming, 4.3% of Medicaid members age 19 and under were on narcotic pain medicines.”

Despite brand-name opioid medications making up 45.1% of costs, generic opioid medications account for 90.6% of all opioid claims among Medicaid members, according to the report. The most prescribed generic drug, hydrocodone-acetaminophen, accounted for 34% of all opioid prescriptions in 2015, while the most prescribed brand-name drug, Suboxone, made up only 8% of all opioid prescriptions.

While examining patients who use opioids, the report also looks at the practitioners prescribing them. Dentists, physician’s assistants, internists, family practitioners, and emergency department physicians all had varying percentages of claims depending on the category of Medicaid beneficiary.

“Predictive modeling can help plans target members who are more likely to be at risk for addiction and abuse, enabling interventions that help the member stay healthy, such as medication counseling, case management, and provider lock-ins when necessary” concludes the report.

The report encourages Medicaid health plans to detect and help members with high opioid utilization. Express Scripts suggests creating programs, limiting opioid supply to high-risk members, and educating prescribers in efforts to avoid overutilization.

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