Methadone Utilization in the U.S., 2002 2006

1
Methadone Utilization in the U.S., 2002 - 2006

• Laura Governale, Pharm.D., MBA
• Team Leader, Drug Utilization Data Specialist
• Division of Surveillance, Research and
  Communication Support
• Office of Surveillance and Epidemiology
• July 20, 2007

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Outline

• Summary of data presented on May 2003, Methadone
  Associated Deaths
• sales and prescription utilization data years
  1998 - 2002
• Current data, Years 2002 - 2006
• Sales data
• IMS Health, IMS National Sales Perspectives
  Retail and Non-Retail
• Prescription and patient-level data new data
  resources
• Verispan, Vector One National (VONA)
• Verispan, Vector One Total Patient Tracker
  (TPT)
• Physician survey data new data resources
• Verispan, Physician Drug and Diagnosis Audit
  (PDDA)
• Conclusions

3
Summary of data presented from May 2003 meeting,
Years 1998 - 2002

• Annual numbers of retail purchases and retail
  prescriptions of methadone have increased over
  the past 5 years1
• Annual numbers of prescriptions for oxycodone,
  morphine, hydrocodone and methadone are
  increasing as well2
• methadone use, by far, the least of these four
  compounds surveyed
• Data do not permit conclusions about use of
  methadone in Opioid Treatment Programs (OTPs).

1 IMS Health, Retail and Provider Perspectives,
Years 1998 2002, Extracted April 2003.
2 IMS Health, National Prescription Audit Plus?,
Years 1998 2002, Extracted April 2003.
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Sales dataYears 2002 - 2006

• IMS Health, IMS National Sales Perspectives
  Retail and Non-Retail

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IMS Health, IMS National Sales Perspectives

• Measures sales data from manufacturers to retail
  and non-retail channels of distribution
• Extended Units are the number of tablets,
  capsules, milliliters, ounces, etc. of a product
  shipped in each unit
• Retail Channels - chain, independent, mass
  merchandisers, food stores with pharmacies, and
  mail-order pharmacies
• Non-Retail Channels - federal facilities,
  non-federal hospitals, clinics, long-term care
  facilities, home health care (began 1998), HMOs,
  miscellaneous channels (began 1999 prisons,
  universities, other)
• unknown number of OTPs in the sample

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Sales data Total extended units of methadone
sold to retail and non-retail channels of
distribution, Years 2002 2006, IMS Health, IMS
National Sales PerspectivesTM
IMS Health, IMS National Sales Perspectives,
Years 2002 - 2006, Extracted July 2007.

• Overall sales of methadone have increased by 89
  between year 2002 and 2006
• Sales in retail channels have doubled since 2002,
  whereas only 59 increase in the non-retail sector

7
Sales data Total extended units of methadone 40
mg sold by channels of distribution, Years 2002
2006, IMS Health, IMS National Sales
PerspectivesTM

• Largest sales increase for the 40 mg strength,
  especially in the retail sector
• slight decrease in sales for non-federal
  hospitals, and clinics.

IMS Health, Retail and Provider Perspectives,
Years 2002 - 2006, Extracted July 2007.
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Prescription and Patient-level DataYears 2002
2006(new data resources)

• Verispan, Vector One National (VONA)
• Verispan, Vector One Total Patient Tracker
  (TPT)

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Verispan, LLC Vector One National (VONA)

• Verispans Vector One National (VONA) is a
  national-level projected prescription and
  patient-centric tracking service.
• Receives over 1.5 billion prescription claims per
  year, representing over 100 million unique
  patients.
• The number of dispensed prescriptions is obtained
  from a sample of approximately 59,000 pharmacies
  throughout the U.S., accounting for nearly all
  retail pharmacies and represent nearly half of
  retail prescriptions dispensed nationwide.
• Retail pharmacies include
• national retail chains,
• mass merchandisers,
• pharmacy benefits managers and their data
  systems,
• provider groups.
• Data on prescribing specialty and patient
  age/gender are available as well as state level
  data.

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Prescription data Proportion of total dispensed
prescriptions for selected opioid drug products,
Years 1997 and 2006, Verispan, VONA
Verispan, VONA, Years 1997 - 2006, Extracted July
2007.
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Prescription data Total prescriptions dispensed
in U.S. outpatient retail pharmacies for
methadone by strength, Years 1997 2006,
Verispan, VONA
Verispan, VONA, Years 1997 - 2006, Extracted July
2007.
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Patient-level data Total number of unique
patients receiving a prescription for methadone
in U.S. outpatient retail pharmacies, Years 2002
-2006, Verispan, Total Patient Tracker (TPT)
Verispan, Total Patient Tracker, Years 2002 -
2006, Extracted July 2007.
13
Annual percent change in prescription volume by
patient age groups
Verispan, VONA, Years 2002 - 2006, Extracted July
2007.
14
Prescription data Methadone prescriptions by
new, continuing, and switch/add-on parameters,
Years 2002 2006, Verispan, VONA
Verispan, VONA, Years 2002 - 2006, Extracted July
2007.

• During year 2006, majority of methadone
  prescriptions are for continuing patients (84)
  versus new patients (2.5) or switch/add-on
  patients (13).

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Projected number of Switch/Add-On new
prescriptions (NRx) for methadone dispensed in
U.S. retail pharmacies, Year 2006

• Most common product dispensed prior to methadone
  prescription is hydrocodone/APAP.

Verispan, VONA, Year 2006, Extracted July 2007.
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Prescription data Total dispensed prescription
for methadone by top 10 prescribing specialties
in U.S. outpatient retail pharmacies, Years 1997
2006, Verispan, VONA
Verispan, VONA, Years 1997 - 2006, Extracted July
2007.

• Beginning year 2005, prescriptions written by
  GPs surpassed anesthesiologists.

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Physician survey dataYears 2002 and 2006(newer
data resources)

• Verispan, Physician Drug and Diagnosis Audit
  (PDDA)

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Verispan, Physician Drug and Diagnosis Audit
(PDDA)

• Office-based physician survey data
• monthly survey that monitors disease states and
  the physician intended prescribing habits on a
  national-level
• designed to provide descriptive information on
  the patterns and treatment of diseases
  encountered in office-based physician practices
  in the U.S.
• audit is composed of approximately 3,100
  office-based physicians representing 29
  specialties across the US
• Limitations
• Denominator is visits - not patients
• Cross-sectional data
• Sample sizes can be small when use is low,
  producing unreliable estimates

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Top 10 diagnoses associated with methadone use
during visits to office-based physicians, Years
2002 and 2006, Verispan, Physician Drug and
Diagnosis Audit (PDDA)
Verispan, PDDA, Years 2002 - 2006, Extracted July
2007.

• Increasing number and proportion of use for
  non-drug abuse conditions.

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Conclusions

• Large growth seen in sales data, especially to
  retail channels.
• More than twice the number of patients in year
  2006 that filled a prescription for methadone
  compared to 2002.
• Most commonly dispensed strength in retail
  pharmacies is 10 mg in the last 10 years.
• Largest growth seen in sales and the number of
  dispensed prescriptions for methadone 40mg.
• Most rapid growth in dispensed prescriptions for
  age 50-64 category followed by the age 17-25
  group.
• During year 2006, majority of methadone
  prescriptions are for continuing patients (84)
  versus new patients (2.5) or switch/add-on
  patients (13).
• Most common product dispensed prior to methadone
  prescription is hydrocodone/APAP.
• More prescriptions prescribed by general
  practitioners than anesthesiologists in 2005 and
  2006.
• Proportion of use for opioid abuse treatment
  declining in year 2006 relative to year 2002.

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Backup slides
22
Prescription data Total number of prescriptions
dispensed for selected opioid drug products,
Years 1997 2006, Verispan, VONA
Verispan, VONA, Years 1997 - 2006, Extracted July
2007.
23
Prescription data Total dispensed prescriptions
for methadone in U.S. outpatient retail
pharmacies by patient age, Years 2002 2006,
Verispan, VONA
Verispan, VONA, Years 2002 - 2006, Extracted July
2007.