Payments For Opioids Shifted Substantially To Public And Private Insurers While Consumer Spending Declined, 1999-2012

Abstract

Deaths from opioid pain reliever overdose in the United States quadrupled between 1999 and 2013, concurrent with an increase in the use of the drugs. We used data from the Medical Expenditure Panel Survey to examine trends in opioid pain reliever expenditures, financing by various payers, and use from 1999 to 2012. We found major shifts in expenditures by payer type for these drugs, with private and public insurers paying a much larger share than patients in recent years. Consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents (a standard reference measure of strength for various opioids) declined from $4.40 to $0.90 between 2001 and 2012. Since the implementation of Medicare Part D in 2006, Medicare has been the largest payer for opioid pain relievers, covering about 20-30 percent of the cost. Medicare spends considerably more on these drugs for enrollees younger than age sixty-five than it does for any other age group or than Medicaid or private insurance does for any age group. Further research is needed to evaluate whether payer strategies to address the overuse of opioids could reduce avoidable opioid-related mortality.

Keywords: Financing Health Care; Health Spending; Insurance Coverage < Insurance; Mental Health/Substance Abuse; Pharmaceuticals.

Exhibit 1. Total US expenditures for opioid pain relievers, by insurance type and year

SOURCE Authors’ analysis. NOTES Expenditures were adjusted by the Medical Expenditure Panel Survey’s pharmaceutical price index, which used 2009 as the base year. The categories of insurance are explained in the text. The overall upward trend in total spending during the study period in Medicare, Medicaid, and private insurance (but not self-pay) was significant (p < 0.001). The larger changes between years, such as between 2010 and 2011 for private insurance (p < 0.01) and between 2006 and 2007 for Medicare (p < 0.05), were also significant, but some of the smaller changes were not. We used Change-Point Analyzer Software to identify changes in trends for spending. For Medicare, private insurance, and total spending, there was such a change in 2006 (99% confidence level). For self or family, there was such a change in 2004 (96% CI).

Exhibit 2. US expenditures for opioid pain relievers for enrollees in Medicare or Medicaid, by age group and year

SOURCE Authors’ analysis. NOTES Expenditures were adjusted by the Medical Expenditure Panel Survey’s pharmaceutical price index, which used 2009 as the base year. Medicare spending for both elderly and nonelderly enrollees increased significantly (p < 0.01) from 2005 to 2006.

Exhibit 4. Total US morphine milligram equivalents (MMEs) prescribed, by payer type and year

SOURCE Authors’ analysis. NOTE The overall trends for MME are significant (p < 0.001).