Opioid Prescribing Decrease and Patient Script Abandonment Increase, According to Recent Study

A significant decline in opioid prescribing and a higher rate of patient abandonment of scripts are among the top trends in IQVIA Institute for Human Data Science’s annual study, “Medicine Use and Spending in the U.S.”

Here are the top 5 trends noted in the report: 

1. Prescription opioid dosage volume dropped 17% in 2018, the single largest annual drop ever in the United States, according to IQVIA.

The record decline is due to changes from all types of regulations, Michael Kleinrock, director of research for the IQVIA Institute, tells Drug Topics. “Federal regulators have introduced class-wide prescribing controls on prescription opioids, while state legislation and regulation have limited prescribing potencies and amounts… Doctors and patients are also contributing to lower volumes by either not prescribing, not filling, or not refilling opioid prescriptions.”

2. Patients’ average out-of-pocket (OOP) costs for retail prescription drugs soared $2 billion to an estimated $61 billion in 2018. Nearly 20% of Medicare Part D patients realized OOP costs higher than $500 annually, while only 8.8% of the broader population had similar OOP expenses, according to IQVIA.

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“The largest driver of higher out-of-pocket costs for Medicare patients are the combined issues of the number of drugs they use,” Kleinrock says. In addition, the cost-sharing model in Medicare Part D results in a consistent 25% of costs for patients up to the catastrophic reinsurance level, which results in higher overall costs. In addition, Medicare Part D patients can’t use coupons as commercially insured patients can, Kleinrock says.

3. The patient abandonment rate of prescriptions at retail pharmacies becomes higher as the cost for the new medication increases. New patient abandonment rates on branded drugs that cost $50 out-of-pocket for those on both commercial health insurance plans and Medicare are 31.2% and 27.6%, respectively. When the prescription cost is above $75, abandonment rates in Medicare exceed those in commercial plans.

“These rates of abandonment have been remarkably stable over time. It is the number of people who are exposed to these cost levels that changes with insurance design shifts, and rising drug costs,” Kleinrock says.

4. Drug spending increased 4.5% net of off-invoice discounts and rebates in 2018, with a 5.7% increase at the invoice level.Spending grew in 2018 due in part to the launch of new branded products as well as an increase in the volume of current branded products, IQVIA says. Discounts, rebates, and other price concessions on brands reduced absolute invoice spending by an estimated 28% to $344 billion.

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“The growth has been primarily driven by the use of newer medicines. Those that are very new (less than two years since launch) and those that launched within the last 5 years make up the majority of spending growth,” Kleinrock says.

5. The number of prescriptions dispensed in 2018 rose 2.7% to 5.8 billion.More than two thirds of total prescriptions last year were for chronic conditions, which are increasingly filled with 90-day prescriptions, IQVIA says. “The largest increase in medicine use in 2018 was seen in antihypertensives, with an increase of 48 million prescriptions filled last year, and mostly driven by an aging population and expanded guidelines to lower blood pressure,” IQVIA says in a statement. 

An increased focus on patient adherence, including incentives in Medicare Part D, is resulting in greater use of 90-day scripts and higher adherence rates among patients with common chronic conditions, according to IQVIA.