Real-World Data Show Exparel Reduces Opioid Use, Costs, and Length of Stay

Pharmacy Times interviews Brendan Teehan, chief commercial officer at Pacira, on new real-world evidence evaluating bupivacaine liposome injectable suspension (Exparel) in postoperative pain management. Data from 4 large claims databases—including those of the Centers for Medicare & Medicaid Services, Optum, Premier, and NorstellaLinQ—demonstrate consistent reductions in opioid use, health care use, and total costs across diverse patient populations and surgical settings. These improvements are driven in part by shorter lengths of stay, fewer complications, and reduced inpatient, outpatient, and emergency department visits. The findings highlight the value of real-world evidence in supporting formulary decision-making, optimizing multimodal pain strategies, and advancing opioid stewardship.

Pharmacy Times: Across the retrospective analyses presented at ASRA, AMCP 2026, and ORS 2026 examining total hip and knee arthroplasty and spinal fusion, can you walk us through the data sources used—such as claims or electronic health record data sets—and how they strengthen confidence in the findings?

Brendan Teehan, Chief Commercial Officer at Pacira: The study findings for each of those come from 4 large-scale claims databases. So that includes the CMS Medicare database for the ASRA data you were discussing, the Optum database for AMCP and ORS. And then Premier; we use the Premier database also [for] the AMCP meeting. And finally, NorstellaLinQ for ORS as well. And the point really is that these databases offer large sample sizes, obviously diverse patient populations that capture different parts of the health care system, which is, I think, critical, and that comprise patient-level health care data on medical claims, pharmacy claims, and related health care resource utilization and expenditures. From our perspective, it’s the robustness and credibility of those real-world findings and the consistency and replication of those results for EXPAREL in the postoperative pain management setting that are improving clinical outcomes, as well as demonstrating economic value through those 4 independent databases.

Pharmacy Times: In these real-world populations, how does a long-acting, nonopioid pain management approach compare with traditional opioid-based regimens in terms of outcomes such as pain control, complications, and functional status?

Teehan: It’s important to point out that across all 4 of these databases, we’re really looking at EXPAREL vs non–liposomally encapsulated bupivacaine, ropivacaine, and other traditional approaches for treating patients. And one of the key outcomes, obviously, is a reduction in opioid use and the adverse events associated with that use. And I think,…most importantly in those large comparisons, is that EXPAREL helps reduce the total cost of care. It does so by improving postoperative pain management. It enhances postsurgical recovery, and it reduces total health care resource utilization over time. So for us, it’s really the consistency of those outcomes across different surgical procedures. So it's in the hip population, the knee population, and the spinal fusion population. It also looks at different types of patients, so Medicare patients, commercial patients, and Medicare Advantage beneficiaries. And then finally, and equally importantly, sites of care. So if it [were] an inpatient population or an outpatient population, you [would] see a very consistent result in improving patient experiences while trying to remove some of the economic barriers to access.

Pharmacy Times: The reductions in health care use and total costs are compelling. What specific components (eg, readmissions, length of stay, post-acute care use) were most impacted, and which are driving the greatest economic value?

Teehan: Among all these studies, the health care cost savings for EXPAREL are…mostly driven by…lower costs of inpatient emergency department and outpatient components; it’s largely due to showing a utilization reduction in each of those 3 settings, and that leads to fewer inpatient readmission or fewer patient inpatient admissions, fewer outpatient visits viewed in that total hip and total knee population, as well as the spine surgical cohorts.

Pharmacy Times: Some of the data point to a shorter length of stay. How clinically meaningful are these reductions, and do they translate differently in inpatient vs outpatient orthopedic settings?

Teehan: You know, the clinical implication for a shorter length of stay for EXPAREL is likely due to the more effective postoperative pain management that EXPAREL delivers, and that leads to improved recovery during follow-up, but also a reduction in surgical complications that would be pain related. So EXPAREL is commonly administered in both the inpatient and outpatient surgical setting. In our total hip study Medicare population, there was a lower incidence of surgical complications in the EXPAREL cohort group as a…defined example of those clinical implications.

Pharmacy Times: Given these findings come from real-world practice rather than randomized trials, how should clinicians and policy makers interpret the strength of the evidence when making decisions about opioid-sparing strategies?

Teehan: Randomized clinical trials tell us whether or not a drug can work under …what I would consider to be ideal conditions as a comparator. But real-world studies are absolutely critical, because they show how products like EXPAREL, for example, actually perform across a diverse set of patients, procedures, and settings, [and] the consistency of those findings across all those 4 databases. And as I said, the different patient populations should give you great confidence about incorporating EXPAREL and how it contributes to lower opioid exposure and, equally importantly, improved recovery metrics. So I think real-world evidence is very compelling in that capacity.

Pharmacy Times: From a pharmacist’s standpoint, how can pharmacists leverage real-world evidence such as this to guide formulary decisions, optimize multimodal pain regimens, and support opioid stewardship in orthopedic care pathways?

Teehan: I think it’s important to look at the totality of the evidence. I mean, in addition to the clinical value, we know EXPAREL, what we’re looking at is the total value, for example, of reduced opioid consumption, reduced length of stay, [and reduced] complication rates. And what are the…downstream savings as a function of that? For example, did the intervention with EXPAREL lead to an earlier discharge, improve postoperative recovery, and reduce health care utilization? I think these data sets tell a very compelling story in that capacity. So my hope, and I think Pacira’s hope, is that pharmacists can leverage that form of real-world evidence to make…targeted value-based formulary decisions, refine any multimodal approaches that they might have, and drive opioid stewardship while also delivering effective pain control with EXPAREL. We hope [these] data [are] additive to people’s collective knowledge of EXPAREL and help people make excellent clinical decisions for their patients.