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Outpatient Drug Utilization Trends for Oxycodone Products

Outpatient Drug Utilization Trends for Oxycodone Products. Laura Governale, Pharm.D., MBA Drug Utilization Analyst Team Leader Division of Epidemiology Office of Surveillance and Epidemiology November 13, 2008. Outline.

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Outpatient Drug Utilization Trends for Oxycodone Products

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  1. Outpatient Drug Utilization Trends for Oxycodone Products Laura Governale, Pharm.D., MBA Drug Utilization Analyst Team Leader Division of Epidemiology Office of Surveillance and Epidemiology November 13, 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 • Oxycodone ER 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. Oxycodone products included • Modified release/Extended-Release (ER) oxycodone products: Oxycodone HCL ER, OxyContin, Oxycodone ER • Immediate-release (IR) oxycodone products: Oxycodone w/APAP, Oxycodone, Endocet, Roxicet, Percocet-5, Percocet-10, Oxycodone w/ASA, Oxydose, Roxicodone, Percocet-7, Roxilox, Percocet-2, Endodan, Tylox, OxyIR, Magnacet, Perloxx, Narvox, Roxicodone Intensol, OxyFast, Oxycodone/Ibuprofen, Percolone, Oxycodone HCl Bulk, Roxiprin, Endocodone, SK-Oxycodone w/APAP, SK-Oxycodone w/ASA

  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 • 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)

  6. Retail pharmacy distribution, 87% Non-retail pharmacy distribution, 13% Projected number of ER oxycodone tablets (in thousands) sold from the manufacturer to retail and non-retail pharmacies in the U.S., Year 2007IMS HEALTH, IMS National Sales PerspectiveTM, Extracted 3/2008

  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 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

  9. Total number of prescriptions dispensed for selected opioids from U.S. outpatient retail pharmacies, Years 1998-2007 SDI Vector One®: National (VONA). Extracted 10/2008 • Hydrocodone products #1 dispensed of entire prescription drug market for the past 10 years • Oxycodone products, ER and IR, over 42 million dispensed prescriptions during year 2007, account for over 24% of market

  10. Total number of prescriptions dispensed for selected opioids (WITHOUT hydrocodone and IR oxycodone products)from U.S. outpatient retail pharmacies, Years 1998-2007 SDI Vector One®: National (VONA). Extracted 10/2008 • Extended-release oxycodone products: ~7.5 million retail Rx in Y2007 • Fentanyl & morphine tied at ~5.5 million retail Rx in Y2007

  11. Majority (~82% Y2007) of oxycodone market is immediate-release products Extended-release market relatively constant at 6-7 million dispensed Rx for last 7 years, account for 18% of entire oxycodone market in Y2007 Total number of prescriptions dispensed for oxycodone products (IR and ER) from U.S. outpatient retail pharmacies, Years 1998 – 2007SDI Vector One®: National (VONA). Extracted 10/2008

  12. Total number of prescriptions dispensed for brand and generic extended-release oxycodone products from U.S. outpatient retail pharmacies, Years 1998-2007 SDI Vector One®: National (VONA). Extracted 11/2008 • Rx volume for Brand dropped by 2/3 between Y2004 (6.1 million Rx) and Y2007 (2.0 million Rx) • Generics account for nearly 5.5 million Rx or 75% of the ER oxycodone market in Y2007

  13. Total number of prescriptions dispensed for all extended- release oxycodone products by strength from U.S. outpatient retail pharmacies, Years 1998-2007SDI Vector One®: National (VONA). Extracted 10/2008 • 20mg leading strength since 1998: 2.4 million Rx in Y2007 (32%) • 40mg second since Y2002: 2.3 million Rx in Y2007 (31%) • 10mg and 80 mg: 1.4 million Rx each in Y2007 (19% each)

  14. Dispensing and prescribing characteristics for ER oxycodone 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 • Average days of therapy per new prescription† • 10mg: 26 days • 20mg, 40mg, 80mg: 28 days • 160mg: 20 days • Most common total daily dose‡: 40mg per day (15%), 20mg per day (14%), 80mg per day (10%), 120mg per day (8%)

  15. ~81% of new Rx dispensed to those had previous Rx for ER oxycodone product within past 3 months ~6% of new Rx had no previous Rx ~14% of new Rx switched or added-on from another pain therapy product Prescription type for ER oxycodone products by new, continuing, and add-switch parameters, Year 2007SDI Vector One®: National (VONA). Extracted 11/2008 *3 month look-back period

  16. Leading prescribers in Y2007: General Practice* 2.1 million Rx (28%), Internal Medicine 1.3 million Rx (18%), Anesthesiology 843,000 Rx (11%) Total number of prescriptions dispensed for all extended-release oxycodone products by top 10 prescribing specialties from U.S. outpatient retail pharmacies, Years 1998-2007SDI Vector One®: National (VONA), Extracted 10/2008 *Family Medicine, Osteopathic Medicine, General Practice †All Others includes Unspecified specialties

  17. Total number of unique patients and prescriptions dispensed for all extended-release oxycodone 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 • ER oxycodone products (brand and generic combined): ~1.5 million patients • Majority of prescriptions dispensed to 40-59 year age group • Younger patients (0-19 years) account for ~1% • On average, 5 prescriptions dispensed per patient per year

  18. Summary of Use for Extended-Release Oxycodone Products, Year 2007… • Hydrocodone products #1 dispensed prescription product • ~119 million Rx • Oxycodone products (ER & IR combined) 2nd among opioids • ER & IR combined: 42.2 million Rx and 14.7 million patients • All ER oxycodone (brand and generic): 7.5 million Rx and ~1.5 million patients • Leading prescribers: General Practitioners (28%), Internal Medicine (18%), Anesthesiologists (11%)

  19. …Summary of Use for Extended-Release Oxycodone Products, Year 2007 • Top dispensed strength • 20mg (32%), 40mg (31%), 10mg (19%), 80mg (19%) • Average days of therapy per new prescription • 10mg: 26 days • 20mg, 40mg, 80mg: 28 days • 160mg: 20 days • Most common total daily dose: 40mg per day (15%), 20mg per day (14%), 80mg per day (10%), 120mg per day (8%) • ~81% of new Rx dispensed to those had previous Rx for ER oxycodone product within past 3 months • ER oxycodone Rxs most commonly dispensed to patients aged 40-59 years • On average, 5 prescriptions dispensed per patient per year

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