Prescription opioid dosages declined 17% in the United States last year, as overall medication use increased.

The drop in opioid volume is the largest ever recorded for a single year in the United States market, according to the IQVIA Institute for Human Data Science.

Opioid volume increased annually from 1992 to 2011, when it reached its highest level, according to the IQVIA’s study Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023.

Since 2011, a series of legislative and regulatory restrictions, combined with greater reimbursement controls and tighter clinical prescribing guidelines, have led to annual declines in opioid volume.

From 2012 to 2016, the average drop per year was 4%. Those decreases were followed by a 12% decline in opioid volume in 2017 and 2018’s 17% drop.

“As the national discussion regarding the opioid epidemic in this country continues, we hope to inform and advance that dialogue with some of the important findings in this report. For instance, while prescription opioid usage continues to decline, we saw many more people receiving medication-assisted treatment (MAT) for opioid addiction,” Murray Aitken, the IQVIA's senior vice president and executive director of the IQVIA Institute for Human Data Science, said in a statement.

“Our research shows new therapy starts for MATs increased to 1.2 million people in 2018, nearly a 300% increase compared with those seeking addiction help in 2014," he said. "This is an important indicator of the effects of increased funding and support for treatment programs to address addiction.”

Prescription drug monitoring programs active in 49 states are limiting the prescribing of high-dose opioids, which are linked to higher overdose and risk dependency.

State-level variability was wide with regards to per capita volume of opioid and MAT prescriptions, according to the IQVIA study.

Arkansas, Oklahoma and Kansas had the highest number of opioid prescriptions relative to MAT prescriptions. All New England states had fewer-than-average opioid prescriptions and higher MAT use.

In 2018, 5.8 billion prescriptions were dispensed, an increase of 2.7% over the 2017.

More than two-thirds of total prescriptions last year were for chronic conditions, which are increasingly filled with 90-day prescriptions, according to IQVIA.

The study credited an aging population and expanded guidelines to lower blood pressure for the 48 million prescription increase in anti-hypertensives, the largest increase for medications.

An increased focus on patient adherence also contributed to greater use of 90-day prescriptions for chronic conditions.

The study also found increases in prescription drug spending.

In 2018, spending grew 4.5% among off-invoice discounts and rebates, and invoice level spending increased 5.7%. Discounts, rebates, and other price concessions on brands reduced absolute invoice spending by an estimated 28% to $344 billion, but 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.

Growth of out-of-pocket costs for patients purchasing retail prescription drugs was estimated at $2 billion between 2017 and 2018. Patient out-of-pocket costs were estimated at $61 billion in 2018, an increase of $5 billion from 2014. 

IQVIA’s study included a forecast that looks forward 5 years. The report predicts that total net spending growth on pharmaceuticals will increase at a compound annual growth rate of 3% to 6% on net price basis and 4% to 7% on invoice price basis, from 2018 to 2023. The baseline scenario also forecasts that net medicine spending in the United States will grow to $420 billion from $344 billion over 5 years and that there will be aggregate growth of $76 billion compared with aggregate net growth of $84 billion through 2023. The largest driver of pharmaceutical spending growth will be the launch of new brands, the study predicts, which could contribute $73 billion of new spending.

The findings released Thursday will be presented and discussed during a webinar on May 14 at 10 a.m., hosted by IQVIA. During the webinar, study author and Institute Research Director Michael Kleinrock will answer questions and offer additional insight.

Reference

IQVI Institute for Human Data Science Releases 2019 Medicines Report on U.S. drug consumption; U.S. Rx opioid volume declined 17% in 2018 – largest single-year drop ever recorded [news release]. Danbury, CT and Research Triangle Park, NC; May 9, 2019: IQVIA website. iqvia.com/newsroom/2019/05/iqvia-institute-for-human-data-science-releases-2019-medicines-report-on-us-drug-consumption-us-rx-o. Accessed May 9, 2019.