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Anti-addiction drug Suboxone is Vermont’s most prescribed drug

The anti-addiction drug Suboxone tops the list of most-used prescriptions in Vermont’s public health insurance system, a new state report shows.
The report says Suboxone claims rose 10.6 percent in fiscal year 2018. The drug, also known as buprenorphine, is used to combat the effects of opioid dependency.
Suboxone also was the No. 1 drug in terms of the state’s gross spending, carrying a cost of nearly $13.3 million. That cost was up almost 19 percent from the year prior.
The numbers are further evidence, officials say, that the state is working to address an addiction epidemic that claimed more than 100 lives last year.
“Vermont is recognizing and treating opioid addiction as a chronic medical condition,” the drug report says. “This has expanded access for those who seek treatment and, in some counties, greatly decreased wait times for those patients.”
The new drug report, from the Department of Vermont Health Access, is an annual accounting of the state’s prescription drug usage and costs for public insurance programs including Medicaid.
Overall, Vermont’s gross cost for prescription drugs was $196.5 million in fiscal 2018 — up about $2.6 million, or 1.4 percent, over the previous year. But the state’s actual spending was much less than that, since manufacturer rebates covered more than 60 percent of the gross cost.
The largest portion of those rebates is set by a federal formula. Factors that drive up rebates include drug utilization and the length of time a drug has been on the market.
Additional rebates also come via the Sovereign States Drug Consortium, which features a dozen states including Vermont, which in 2005 become one of the founding members.
“Those states band together and try to negotiate additional rebates with manufacturers,” said Cory Gustafson, commissioner of the health access department.
Vermont uses several other cost-control strategies including a preferred drug list, a Drug Utilization Review Board and a prior authorization program, which requires prescribers to submit a request for coverage of some drugs.
Because of such efforts, Gustafson said year-over-year increases in the state’s gross drug costs shouldn’t be considered in isolation. Rather, he said, there’s an active management program that is responding to changes in drug utilization, policy and prices.
“We’re doing a decent job at managing our pharmacy overall costs, both net and gross,” Gustafson said.
In addition to providing a glimpse of Vermont’s overall drug costs and its cost-cutting strategies, the new report also offers a detailed look at the specific drugs that dominate the state’s public insurance programs.
Suboxone’s presence at the top of the list is not a surprise, officials said. Vermont’s hub and spoke system of medication-assisted treatment has been growing as part of a strategy to combat opiate addiction.
In fiscal 2018, “the number of claims for all buprenorphine-containing drugs increased by 8.3 percent, while the utilization of Suboxone increased by 10 percent … supporting the trend toward more patients with opiate use disorder accessing treatment,” the report says.
However, the report also shows that the use of prescription opioids declined by 30 percent last fiscal year. And the number of members in the state’s insurance programs who used opiates decreased by 36 percent.
The state has enacted tougher guidelines on opioid prescribing in an effort to curb addiction. While such measures are controversial, they have had a clear, immediate effect on the number of prescription painkillers in circulation.
In addition to those rules, “educational initiatives and awareness around treating chronic pain differently without the use of opioids is also a contributing factor,” the state’s report says.
Other drug-utilization highlights from the report include:
•  Specialty drugs accounted for 24.2 percent of the state’s drug spending in fiscal 2018, up from 20.7 percent the year prior. The report projects continued increases in specialty medications including those for cancer, HIV and attention deficit hyperactivity disorder (ADHD) treatment.
•  Generic drugs make up 79 percent of all drugs dispensed in the state’s programs. But brand-name drugs account for 83 percent of the state’s costs.
•  In terms of gross spending, the second-ranking drug behind Suboxone was Humira, an anti-inflammatory used to treat conditions like rheumatoid arthritis and Crohn’s disease. Gross costs for Humira — before rebates — were $7.9 million, a 54 percent increase from the year prior.
•  Rounding out the top five in gross spending were Vyvanse (ADHD), methylphenidate (ADHD) and Epclusa (hepatitis C). The report notes a jump in the number of people undergoing hepatitis C treatment.
•  Behind Suboxone, the top drugs in terms of utilization were Proair (asthma), methylphenidate (ADHD), gabapentin (nerve pain and seizure control) and sertraline (antidepressant).
•  Prescriptions for amoxicillin were up by more than 1,000 in fiscal 2018, which the report’s authors found “somewhat surprising since there has been a focus on antibiotic overuse and concerns about resistance.” Officials theorize that a severe flu season might be to blame.
•  The report noted downward trends in proton pump inhibitors (used to treat heartburn and ulcers) and clonazepam, a benzodiazepine that can be prescribed for seizures, panic disorders and anxiety. Officials noted educational efforts to reduce the prescription of those drugs amid “a growing body of evidence that demonstrates the risks of long-term use with both categories of medicine.”

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