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Outpatient Drug Utilization Trends for Extended-Release Morphine Products

Outpatient Drug Utilization Trends for Extended-Release Morphine Products. Laura Governale, Pharm.D., MBA Drug Utilization Analyst Team Leader Division of Epidemiology Office of Surveillance and Epidemiology November 14, 2008. Outline.

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Outpatient Drug Utilization Trends for Extended-Release Morphine Products

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  1. Outpatient Drug Utilization Trends for Extended-Release Morphine Products Laura Governale, Pharm.D., MBA Drug Utilization Analyst Team Leader Division of Epidemiology Office of Surveillance and Epidemiology November 14, 2008

  2. Outline • Sales distribution analysis: IMS Health, IMS National Sales Perspectives™ Retail and Non-Retail • Dispensed prescription analysis: SDI Vector One®: National (VONA) • Opioid market • ER morphine products • Dispensing and prescribing characteristics • Prescriber specialty • Patient-level analysis: SDI Vector One®: National (VONA) and SDI Total Patient Tracker (TPT) • Age distribution • Summary

  3. Morphine products included • Modified release/Long-acting (LA)/Extended- release (ER) morphine sulfate products: Morphine Sulfate ER (generics), Kadian (Alpharma), Avinza (Ligand), MS Contin (Purdue Pharma), Oramorph SR (Xanodyne) • Immediate-release (IR) morphine sulfate products: Morphine Sulfate Non-Injectable, Morphine Sulfate IR, MSIR, Roxanol, Roxanol 100, Morphine Sulfate Injectable, Roxanol-T, MSIR, Roxanol UD, Rescudose, OMS, MS/L

  4. Sales distribution dataYear 2007 IMS Health, IMS National Sales Perspectives™ Retail and Non-Retail

  5. IMS Health, IMS National Sales Perspectives™ • Measures the volume of products, in units and dollars, moving from manufacturers to retail and non-retail channels of distribution • Eaches represent the number of single items (such as vials, syringes, bottles, or packet of pills) contained in a unit or shipping package and purchased by providers and pharmacies in a specific time period. An eache is not a single pill or dosage of medicine (unless one package consists of a single dose). An eache may be the same as a unit if the unit does not subdivide into packages. • 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)

  6. Projected number of bottles, vials, and packets of morphine sulfate products sold from the manufacturer to retail and non-retail pharmacies in the U.S., Year 2007IMS HEALTH, IMS National Sales PerspectiveTM, Extracted 11/2008. • Over 70% of oral solid products, both IR and ER, toward retail pharmacy channels • Nearly 85% of oral liquid products toward non-retail distribution

  7. Prescription and Patient-level Data SDI Vector One®: National (VONA) SDI Vector One®: Total Patient Tracker (TPT)

  8. Surveillance Data, Inc. Vector One®: National (VONA) • SDI’s Vector One®: National (VONA) is a national-level projected prescription and patient-centric tracking service. • Receives over 2.0 billion prescription claims per year, representing over 160 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 representing nearly half of retail prescriptions dispensed nationwide. • Retail pharmacies include: • national retail chains • mass merchandisers • pharmacy benefits managers and their data systems • provider groups • Available data • Prescribing specialty and patient demographics • New, continuing, add/switch

  9. Hydrocodone (67%) and oxycodone (24%) products account for over 90% of market Morphine products (and fentanyl products) accounted for 3% of market Proportion of prescriptions dispensed for selected opioids from U.S. outpatient retail pharmacies, Year 2007 SDI Vector One®: National (VONA). Extracted 10/2008

  10. Total number of prescriptions dispensed for selected opioids (bottom 10% of Y2007 market – c/o hydrocodone and oxycodone)from U.S. outpatient retail pharmacies, Years 1998-2007 SDI Vector One®: National (VONA). Extracted 10/2008 • Year 2007 TRx • All morphine products (both IR and ER) at ~5.5 million • Fentanyl 5.5 million Rx • Methadone 4.2 million Rx • Hydromorphone 1.6 million Rx

  11. Total number of prescriptions dispensed for ER and IR morphine products U.S. outpatient retail pharmacies, Years 1998 – 2007SDI Vector One®: National (VONA). Extracted 11/2008 • ER morphine products quadrupled in 10 years from ~1 million Rx in Y1998 to ~4.2 million Rx in Y2007 • Proportion increased from 64% to 75% over 10 years • IR market (tabs, solution, drops, concentrate) also increased from ~500 thousand Rx in Y1998 to ~1.3 million Rx in Y2007

  12. Total number of prescriptions dispensed for extended-release morphine products by manufacturer from U.S. outpatient retail pharmacies, Years 1998-2007 SDI Vector One®: National (VONA). Extracted 11/2008 • Generic morphine sulfate ER accounting for over 70% (~3 million Rx) of all extended-release morphine sulfate market • Kadian 15% (614,000 Rx), Avinza 13% (546,000 Rx), MS Contin 1% (55,500 Rx)

  13. Dispensing characteristics for ER and IR morphine products from U.S. outpatient retail pharmacies, Year 2007†SDI Vector One®: National (VONA). Extracted 10/2008‡SDI Physician Drug and Diagnosis Audit (PDDA), Extracted 11/2008 • Top dispensed strength† • ER morphine sulfate: 30mg (35%), 60mg (23%), 15mg (19%), 100mg (11%) • IR morphine sulfate tabs: 15mg (56%), 30mg (39%), 10mg (5%) • Solution, concentrate and drops: 20mg • Most common total daily dose‡: 60mg per day (25%), followed by 120mg per day (13%) • Average days of therapy per new prescription† • ER morphine: 28 days • IR morphine: 22 days

  14. Prescription type for ER and IR morphine products by new, continuing, and add-switch parameters*, Year 2007SDI Vector One®: National (VONA). Extracted 11/2008 • ER formulation • Majority of prescription transactions from continuing patient prescriptions, 80% • New patient prescriptions, ~4.5% • IR formulations • New patient prescriptions and add/switch transactions more common, esp. liquids *3 month look-back period

  15. Leading prescribers in Y2007: General Practice† 1.0 million Rx (24%), Anesthesiology 771,000 Rx (17%), Internal Medicine 669,000 Rx (16%) Total number of prescriptions dispensed for ER morphine sulfate products by top 10 prescribing specialties from U.S. outpatient retail pharmacies, Year 2007SDI Vector One®: National (VONA), Extracted 11/2008 *All Others includes Unspecified specialties † Family Medicine, Osteopathic Medicine, General Practice

  16. Total number of unique patients and prescriptions dispensed for all ER morphine sulfate products from U.S. outpatient retail pharmacies, Year 2007 SDI Vector One®: National (VONA), Data Extracted 11/08 SDI Total Patient Tracker, Extracted 11/08 • Total patients for all oral morphine sulfate products: 1.2 million patients • ER morphine sulfate products (brand and generic combined): ~867,000 patients • IR morphine sulfate (brand and generic):~452,500 patients • Majority of patients and prescriptions dispensed to 40-59 year age group. • Younger patients (0-19 years) account for <1% for both patient numbers and Rx. • On average, 5 prescriptions dispensed per patient per year

  17. Summary of Use for Extended-Release Morphine Products, Year 2007… • Morphine sulfate products (ER & IR combined) 2nd among opioids • ER & IR combined: 5.5 million Rx and 1.2 million patients • ER morphine sulfate (brand and generic): 4.2 million Rx and ~867,000 patients • IR morphine sulfate (brand and generic): 1.3 million Rx and ~452,500 patients • Market share for extended-release morphine sulfate products • Generics > 70% • Kadian 15% • Avinza 13% • MS Contin 1% • Leading prescribers: General Practitioners (24%), Anesthesiologists (17%), Internal Medicine (16%)

  18. …Summary of Use for Extended-Release Morphine Products, Year 2007 • Most dispensed strength: 30mg • Most prescribed daily dose: 60mg • Average days of therapy per prescription: 28 days • Over 80% of new prescription transactions are for continuing patient prescriptions • Over half of all patients and prescriptions dispensed to 40-59 year age group • Younger patients (0-19 years) account for <1% for both patient numbers and Rx • On average, 5 prescriptions dispensed per patient per year

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