Center for Behavioral Wellness, Nashville, TN, USA.
Channel BioConsulting, Inc, Raleigh, NC, USA.
Adv Ther. 2018 Apr;35(4):457-466. doi: 10.1007/s12325-018-0696-y. Epub 2018 Apr 6.
A large, statewide, fee-for-service Medicaid plan recently (October 2015) executed a complete switch from sublingual buprenorphine-naloxone [(SLBN), Suboxone] to buccal buprenorphine-naloxone [(BBN), Bunavail] on its preferred drug formulary. This complete formulary switch provided an opportunity to assess dynamic changes in prescribing patterns, patient/physician acceptance, and indices of potential misuse/diversion.
For the period January 1, 2015 through December 31, 2016, two datasets were analyzed: prescriptions and associated costs for buprenorphine-naloxone (BN) products and urine toxicology test results for patients in the Medicaid plan. The dataset comprised 1370 unique providers ordering 643,225 prescriptions for opioid addiction therapy. Patient and order volumes, and the rate of monthly positive laboratory values for opioid molecules and cocaine were reviewed. A targeted survey of physicians treating opioid-dependent patients with state Medicaid plan coverage was also conducted.
Upon plan conversion to BBN, there was a rapid increase in monthly BBN prescriptions mirrored by a rapid decrease in SLBN prescriptions. Peak in BBN prescriptions (2633 in November 2015) was approximately 60% lower than peak in SLBN prescriptions (6531 in July 2015). An unexpected finding was a 68% reduction of the overall BN market, indicating that many BN prescriptions were abandoned. The reduction was associated with quarterly cost savings to the Medicaid plan of approximately $3.5 million. Toxicology results indicated a reduction in drug positivity (defined as positivity for cocaine and/or any opioids except buprenorphine and methadone) from 13-16% in 2015 to less than 10% in 2016. Heroin positivity decreased from approximately 9% in December 2015 to an average of less than 1% during the last quarter of 2016, while positivity for norbuprenorphine, the major metabolite of buprenorphine, showed a marked increase in 2016 vs 2015. Among physicians who responded to the targeted survey most rated BBN as more difficult to abuse or misuse than SLBN.
The rapid reduction in the overall BN market following a complete formulary switch from SLBN to BBN was associated with quarterly savings of $3.5 million for the state Medicaid plan. Toxicology data suggest that this cost saving was realized in the context of improved physician and patient adherence to treatment protocols. The changing market dynamics can potentially be explained by a number of contributory factors, including a reduction of diversion and illicit distribution of BN following formulary conversion. These results are considered hypothesis-generating and future research should systematically compare the propensity for diversion and abuse of BN products using various epidemiological tracking tools.
BioDelivery Sciences International, Inc.
最近（2015 年 10 月），一个大型的全州性、按服务收费的医疗补助计划完全改变了其首选药物处方，将舌下丁丙诺啡-纳洛酮（SLBN，Suboxone）换成颊用丁丙诺啡-纳洛酮（BBN，Bunavail）。这种完全的配方转换提供了评估处方模式、患者/医生接受度和潜在滥用/转移指标的动态变化的机会。
在 2015 年 1 月 1 日至 2016 年 12 月 31 日期间，分析了两个数据集：医疗补助计划中患者的丁丙诺啡-纳洛酮（BN）产品的处方和相关费用，以及尿液毒理学检测结果。该数据集包括 1370 名开出处方的独特提供者，开出了 643225 份治疗阿片类药物成瘾的处方。审查了患者和订单数量，以及每月阿片类药物分子和可卡因阳性实验室值的比率。还对使用州医疗补助计划治疗阿片类药物依赖患者的医生进行了有针对性的调查。
在计划转换为 BBN 后，BBN 处方迅速增加，而 SLBN 处方迅速减少。BBN 处方的峰值（2015 年 11 月为 2633 份）比 SLBN 处方的峰值（2015 年 7 月为 6531 份）低约 60%。一个意想不到的发现是 BN 市场整体下降了 68%，表明许多 BN 处方被放弃了。这种减少与医疗补助计划每季度节省约 350 万美元的费用有关。毒理学结果表明，药物阳性率（定义为可卡因和/或除丁丙诺啡和美沙酮以外的任何阿片类药物阳性）从 2015 年的 13-16%降至 2016 年的不到 10%。海洛因阳性率从 2015 年 12 月的约 9%降至 2016 年最后一个季度的平均不到 1%，而丁丙诺啡的主要代谢物去甲丁丙诺啡的阳性率在 2016 年比 2015 年显著增加。在回应有针对性调查的医生中，大多数人认为 BBN 比 SLBN 更难滥用或误用。
在完全从 SLBN 切换到 BBN 的药物配方后，BN 市场的整体迅速减少，这为州医疗补助计划节省了 350 万美元的费用。毒理学数据表明，这种成本节约是在医生和患者更好地遵守治疗方案的情况下实现的。市场动态的变化可能可以用一些促成因素来解释，包括在配方转换后，BN 的转移和非法分发减少。这些结果被认为是产生假说的，并应使用各种流行病学跟踪工具系统地比较 BN 产品的滥用和滥用倾向。
BioDelivery Sciences International，Inc.
