Insurers picking up more of the cost of opioid prescriptions, CDC study says

Insurers are picking up more of the cost of prescription pain drugs, according to a study linking that trend with the rise in opioid-related deaths.

In 1999, 53 percent of spending on prescription pain medicine came from consumers paying out-of-pocket costs, compared to 18 percent in 2012, according to the Centers for Disease Control and Prevention study published in Health Affairs.

Out-of-pocket spending on opioids declined from $4.40 in 2001, to 90 cents 2012, the study said.

[Also: Opioid epidemic causing more hospitalizations, increasing hospital costs, study finds]

Insurance, both private and public, is now bearing a much larger share of the drug costs, the authors said.

Medicare is the leading payer due to the implementation of Medicare Part D in 2006, the study said. Medicare now accounts for 20 to 30 percent of the cost, spending considerably more for enrollees younger than age 65.

The shift in payer burden is due to policy changes in the past decade. Since 1999, there have been major shifts in third-party payment for opioid pain relievers, the study said.

[Also: CMS, Joint Commission pressed to change policies that promote opioid pain medicine overuse]

In the 1990s there was a change in the medical treatment of pain after specialists argued that selected patients with chronic non-cancer pain could be successfully treated with opioid pain relievers.

In 1998 the Federation of State Medical Boards published guidelines that suggested flexibility in pain management, including broader use of opioids. The Joint Commission required providers to assess pain during most patient encounters.

The Veterans Health Administration incorporated routine assessment of pain as the "fifth vital sign" in 2000, the study said.

"All of these changes in pain management coincided with a dramatic increase in the medical use of opioid pain relievers, starting in the 1990s," the authors said. "In the same time period some pharmaceutical companies conducted extensive campaigns to promote the use of the drugs."

Also in the 1990s, they said, employees' health plans increasingly included prescription drug coverage.

[Also: FDA approves Narcan nasal spray for opioid overdoses, hopes for wider, safer use]

However, the study's authors said there's been no systematic research on expenditure patterns for opioid pain relievers across different payers. Nor has any research analyzed different demographic groups within each payer.

Their study concentrated on the Medicare population, according to authors Chao Zhou, Curtis S. Florence, and Deborah Dowell, with the CDC.

The decrease in consumer out-of-pocket spending for prescription pain relievers has coincided with the opioid overdose epidemic, the study said. The majority of drug overdose deaths are associated with  opioid pain relievers such as oxycodone and methadone.

Annual deaths from opioid overdose quadrupled in the United States between 1999 and 2013, from 4,030 to 16,235, according to the study. The majority of these deaths occur among adults ages 25 to 64 years old, but overdose mortality has grown faster among people ages 55 to 64 years old than among any other age group, it said.

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The CDC said it is working with communities and prescribers to prevent opioid misuse and is developing opioid prescribing guidelines.

Prescription opioid drug spending grew dramatically from 1999 to 2012. Americans spent $2.3 billion on prescription opioids in 1999. By 2006, spending had almost tripled to over $7 billion.

In 1999, out-of-pocket spending was $1.2 billion out of the $2.3 billion spend on opioid pain relievers. By 2012, out-of-pocket spending had increased to $1.3 billion, but that represented just 18 percent of the total $7.4 billion spent, the study said.

Twitter: @SusanJMorse