# Presentation: 235018

## 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

**Sales distribution analysis:  IMS Health, IMS National Sales Perspectives****TM**** 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**

## 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 **

## Sales distribution dataYear 2007

**IMS Health, IMS National Sales Perspectives****TM**** Retail and Non-Retail**

## IMS Health, IMS National Sales PerspectivesTM

**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)**

## 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 2007IMS 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**

## Prescription and Patient-level Data

**SDI Vector One****®****:  National (VONA)**
**SDI Vector One****®****:  Total Patient Tracker (TPT)**

## 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 **

## Proportion of prescriptions dispensed for selected opioids from U.S. outpatient retail pharmacies, Year 2007 SDI Vector One®: National (VONA).  Extracted 10/2008

- Hydrocodone (67%) and oxycodone (24%) products account for over 90% of market
- Morphine products (and fentanyl products) accounted for 3% of market

## 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

## Total number of prescriptions dispensed for ER and IR morphine products U.S. outpatient retail pharmacies, Years 1998 – 2007SDI 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

## 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)

## 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

## Prescription type for ER and IR morphine products by new, continuing, and add-switch parameters*, Year 2007SDI 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

## Total number of prescriptions dispensed for ER morphine sulfate products by top 10 prescribing specialties from U.S. outpatient retail pharmacies, Year 2007SDI Vector One®: National (VONA),  Extracted 11/2008

- Leading prescribers in Y2007:  General Practice† 1.0 million Rx (24%), Anesthesiology 771,000 Rx (17%), Internal Medicine 669,000 Rx (16%)

- *All Others includes Unspecified specialties
- † Family Medicine, Osteopathic Medicine, General Practice

## 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

## 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%)

## ...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