Public, private payer data shine spotlight on opioid epidemic

Spending on Medicaid-covered prescriptions to treat opioid use disorder and overdoses increased 136% between 2011 and 2016. (Getty/smartstock)

Two new reports involving data from private and public payers demonstrate just how pervasive—and costly—the country’s opioid epidemic has become.

One report, conducted by the Blue Cross Blue Shield Association (BCBSA), found that 21% of its commercially insured members filled at least one opioid prescription in 2015.

In addition, the share of BCBS members with an opioid use disorder diagnosis spiked 493% from 2010 to 2016, with a “marked increase” in diagnoses starting in 2014. That increase, the report said, is likely at least partially due to greater awareness of the disorder.

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The report also found a 65% rise in the use of medication-assisted treatments during that time period, though it noted states with the greatest growth were not necessarily those most affected by opioid use disorders. The South and parts of the Midwest had lower treatment rates, for example, than New England.

Further, the report found that opioid prescriptions are not all equally dangerous. An opioid use disorder diagnosis is seven times more likely in patients who fill high-dose, long-duration regimens than it is for those who fill low-dose, long-duration regimens.

Opioid prescriptions for chronic conditions, the report adds, are three times as likely to reach that risky “high dose” level, and two times more likely to extend past 45 days.

“Blue Cross and Blue Shield companies around the country recognize their responsibility to respond and do their part to address this terrible crisis,” Kim Holland, vice president of state affairs for the BCBSA, said in a statement.

Indeed, last April the BCBSA formed an executive committee composed of clinicians, chief medical officers, fraud experts, government affairs leaders and pharmacy leaders to improve opioid prescribing practices and help members manage addiction.

Cost pressures for Medicaid

Another new report, meanwhile, highlighted the high financial costs of the opioid crisis—in this case, for a major public payer.

The report, conducted by the Urban Institute, examined state Medicaid drug utilization files and found that spending on Medicaid-covered prescriptions to treat opioid use disorder and overdoses increased 136% between 2011 and 2016, from $394 million to $930 million.

While most of the money went toward buprenorphine, spending on the two other medications—naltrexone and naloxone—experienced the most dramatic spending increase, rising 1,072% and 90,205%, respectively from 2011 to 2016.

States with the highest overdose mortality rates in 2015, including Kentucky, Massachusetts, Ohio, Rhode Island and West Virginia, saw particularly fast spending growth in opioid use disorder treatment between 2011 and 2016.

Those same states, the report adds, “could be particularly hard hit by potential reductions in Medicaid spending growth.”

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