Report: Cost drives formulary decisions on pain meds

Cost is the primary non-efficacy factor that drives decisions on which pain medications to include in formularies, according to a survey that included hospital pharmacy directors.

The findings are part of Decision Resources Group’s (DRG) U.S. Physician & Payer Forum report, “Acute Moderate to Severe Postoperative Pain: How Will U.S. Prescribers and Payers Determine the Success of Emerging Pain Therapies in the Hospital Setting?”

DRG surveyed 31 hospital pharmacy directors and 102 anesthesiologists and surgeons about their prescribing and formulary decisions relating to opioids.

Andrea Buurma“Formulary inclusion may prove challenging if novel pain therapies are priced notably [higher] than currently available agents in their respective drug classes,” said Andrea Buurma, a DRP analyst. “However, clinical trial data that clearly demonstrate cost-benefit advantages such as reduction in hospital readmissions for pain, shorter length of stay, or reduction in overall costs to the hospital can be leveraged to secure more favorable formulary coverage."

The physicians and pharmacy directors surveyed also said that reducing postoperative opioid consumption and lowering the incidence of opioid-related adverse events remain two of the biggest issues in postoperative pain treatment.

According to DRG, most branded therapies are subject to formulary restrictions or are excluded from hospital formularies. “For instance, Cumberland Pharmaceuticals’ Caldolor and Pacira’s Exarel are not included in the majority of surveyed pharmacy directors’ formularies, likely because well-established alternatives with generic availability exist in these agents’ respective drug classes,” the report stated.

Most important driver

DRG cited “notable use” of Ofirmev, the only parenteral formulation of acetaminophen in the United States, among surgeons and anesthesiologists as well as widespread coverage (with restrictions) in the majority of surveyed hospital pharmacy directors' formularies.

“Surveyed physicians and hospital pharmacy directors cite the agent's efficacy in reducing postoperative opioid consumption as the most important attribute driving prescribing and coverage, respectively,” the DRG report stated.

Physicians would welcome new pain therapies, such as Durect's Posidur, a long-acting bupivacaine injection, into their postoperative pain treatment armamentarium, the report stated.

“However, their likelihood to prescribe/administer emerging therapies and their expected use of these products across select procedures will be largely dependent on formulary coverage,” Buurma said.