A recent report from the Centers for Disease Control (CDC) found an increase in the prevalence of hepatitis C and HIV due to injectable opioid abuse.
The report found a number of individuals became infected with hepatitis C after beginning oral oxycodone treatment and within a year transitioning to the injection of heroin. Needle sharing among drug users has rapidly led to the spread of hepatitis C.
Hepatitis C: Result of Opiate Abuse
Prescription opioid misuse has reached a significant level among young persons, with almost one-fourth of 18- to 25-year olds reporting lifetime misuse of prescription opioids – an elevated use beyond medical professional pain management best practices.
Behavioral issues are fueling the flame. Young injectors who engage in receptive needle or syringe sharing experience a 35% hepatitis C incidence rate, compared with a 17% incidence rate for those who do not.
Young persons are more likely to inject within a particular social context, such as pooling money to purchase drugs, resulting in concomitant obligations to inject together. Nearly 45% of young injectors are estimated to be infected with hepatitis C.
Acute hepatitis C is often asymptomatic, and young injectors tend not to seek medical care until the disease is in a late stage.
Express Scripts expects spending on the hepatitis C therapy class will increase by 200% in both 2015 and 2016, pointing to the ongoing challenges these drugs will pose to payers and patients seeking access to these breakthrough medications.
Resurgence of HIV
HIV infection is also on the rise due to opiate abuse.
The state of Indiana is seeing the worst outbreak of HIV in decades. Health officials have confirmed 149 cases of HIV in Austin, Indiana since December 2014. These cases stem from needle sharing among people who injected a liquefied version of the painkiller Opana.
Today, 1.2 million Americans over 13 are living with HIV and approximately one-fourth of new infections occur in people 13-24. The median monthly cost per HIV prescription is more than $1000.
Over the next three years, both hepatitis C treatment and HIV treatment are expected to see significant per-member-per-year annual spend increases.
Concerns of Overprescribing
Recent concerns have emerged around overprescribing controlled narcotic medication, specifically schedule II and III narcotic pain medication.
In one example, schedule II and III controlled substance narcotic pain medications accounted for 66% (5,999 out of 9,050) of all prescriptions written by one prescriber. This represents nearly twice as many prescriptions per patient than this prescriber’s peer group.
Opioid Insights and Best Practices
Early detection is critical for stopping this behavior.
In order to reduce opioid abuse, Express Scripts’ Fraud, Waste & Abuse program – which includes an optional lock-in program – restricts certain patients to one pharmacy and, in some cases, to one prescriber for controlled substances and muscle relaxers.
Clients who implement this solution see an 83% reduction in controlled substance claims, 81% decrease in controlled substance spend and 72% decrease in total drug spend compared with the period prior to lock-in.
If you or someone you know has identified an abuse issue. Please seek help by contacting the Express Script Fraud Tip Hotline at 866.216.7096 or using our online form to report suspicious activity.
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