Medicaid Claims Data Abby Hammond Cost of Drugs for Individuals Served by Ohio Department of Developmental Disabilities Medicaid Claims Data Abby Hammond

Who Does This Analysis Include? Medicaid claims data was used to gather information about individuals who are served by the Ohio Department of Disabilities, and who had Medicaid claims in 2015. The 73,061 people served by DODD who had known Medicaid numbers were included in the analyses. Medicaid data captures the Ohio Dodd population well as most individuals within this population are Medicaid members. Ohio DODD serves about 94,254 individuals, of which about 73,061 have Medicaid members.

Cost of Drugs for Individuals Served by the Ohio Department of Developmental Disabilities Medicaid Claims Data

The total number of prescriptions filled was 1,978,717 Here we see that in terms of total number of prescriptions filled, the category with the most prescriptions is CNS drugs. There were almost 500,000 more CNS drug prescriptions than Gastrointestinal Drug prescriptions, which is the category with the second highest total number of prescriptions. The total number of prescriptions filled was 1,978,717

68,140 of the 73,061 people in the population had at least one prescription Therapeutic Class removed if less than 1000 people The top drug class with Unique people receiving prescriptions (meaning each individual is only counted once, even if they have refill prescriptions) is CNS drugs. 29,362 individuals received CNS drugs Note The total number of individuals receiving prescriptions is 68,140, this is not the same as adding all the data in this graph together, as some individuals received prescriptions for more than 1 drug class. For example, one individual may have a prescription for both Anti-infective Agents and Autonomic Drugs

What are the Top 10 Most Costly Therapeutic Drug Classes for Ohioans with Developmental Disabilities? Now that we have looked at utilization, we can look into the cost of the drugs being prescribed and address the question, what are the top 10 most costly therapeutic drug classes. In the next few slides we will address this question by looking at 3 three different cost measures.

Top 10: Drug Classes with the Highest Medicaid Costs This pie chart looks at Cost Per Perscription. This refers to the amount of submitted charges eligible for prescriptions filled. It is the amount eligible after applying pricing guidelines, but before deducting third party, coinsurance, or deductible amounts. Again we see that among the total Allowed Amount Rx for Drug classes with the highest Allowed Amount Rx, CNS Drugs make up a very large proportion.

On average, the cost per person was $466. 06 for calendar year 2015 On average, the cost per person was $466.06 for calendar year 2015. The median cost per person was $301.43. This graph shows the cost of drugs (by drug class) for Patients prescribed. The cost per patient was calculated by dividing the mediciad cost per person (as seen on the previous slide) by the count of unique people receiving prescriptions within each drug class. . The total number of individuals who received prescriptions was 68140, and there were 1,978,717 prescriptions filled. We see a big difference between CNS drugs and the other 9 classes comprising the top 10. On average, the cost per person was $466.06. The median cost per person was $301.43. The median is a better estimate as there is a very large, skewed range.

What is Included in Central Nervous System (CNS) Drugs Class?

Aspirin, Ibuprofen, Meloxicam, Nabumetone, Naproxen Subcategories Examples Anticonvulsants Zarontin, Celontin, Klonopin, Valium,Diastat, Ativan, Epson Salt, Vimpat Painkillers Aspirin, Ibuprofen, Meloxicam, Nabumetone, Naproxen  Opiate Agonists Narcan, Morphine, Oxycodone, Fentanyl, Codeine, Hydromorphone, Hydrocodone, buprenorphine Psychotherapeutics Celexa, Haldol, Zoloft, Prozac, Pristiq, Kdedezla, Cymbalta, Clozapine Stimulants Adderall, Dextrine, Dextrostat, ProCrntra, Vyvanse , Concerta, daytrana, Ritalin, Methylin,Focalin Sedatives Amobarbital, Zetram, Niravam, Xanax, Doral CNS Misc. Rilutek, Nudexta, Ampyra, Hydergine There are 19 drug classes within the CNS drug class. We have collapsed these 19 drug classes into 7 subcategories.

How do the Subcategories of the CNS Drug Classes Compare in Terms of Utilization by Ohioans with Developmental Disabilities?

In total, there were 707, 020 prescriptions for CNS drugs. The subcategories with the largest total number of prescriptions filled were Psycho therapeutic drugs and Anticonvulsants The subcategories with the smallest total number of prescriptions filled were opiate agonists and Miscellaneous CNS drugs

Number of Prescriptions Filled When looking at the distribution of prescriptions among unique people, we see again that The subcategories with the largest total number of prescriptions filled were Psycho therapeutic drugs and Anticonvulsants with 20,537 individuals. The subcategories with the smallest total number of prescriptions filled were opiate agonists (4678)and Miscellaneous CNS drugs (1382) Note The total number of individuals receiving prescriptions is 68,140, this is not the same as adding all the data in this graph together, as some individuals received prescriptions for more than 1 drug class. For example, one individual may have a prescription for both Anti-infective Agents and Autonomic Drugs Number of Prescriptions Filled

How do the Subcategories of the CNS Drug Classes Compare in Terms of Cost for Ohioans with Developmental Disabilities? Now that we have looked at utilization, we can look into the cost of the drugs being prescribed and address the question, How do the Subcategories of the CNS Drugs Class Compare in Terms of cost? In the next few slides we will address this question by looking at 3 three different cost measures, the same three that we looked at earlier in this presentation.

This pie chart looks at Prescription Costs This pie chart looks at Prescription Costs. This refers to the amount of submitted charges eligible for prescriptions filled. It is the amount eligible after applying pricing guidelines, but before deducting third party, coinsurance, or deductible amounts. Again we see that among the total Allowed Amount Rx for all of the subcategories, Most of the Allowed Amount Rx belongs to Anticonvulsants and Psychotherapeutic Drugs. Combined, they account for 86% of the allowed Amount Rx for all CNS drugs.

(Notes from previous slide) This graph shows the cost of drugs (by drug class) for Members(Medicaid’s unique count of members with any coverage twice. Each member is counted once regardless of their number of eligible months). The cost per member was calculated by dividing the Allowed amount RX (as seen on the previous slide) by the Total number of members (73,061). Again we see a big difference between the cost fewr member for Anti convulsants and Psycotheraputic drugs in comparison to the five other subcategories of CNS drugs. The Cost per member for anticonvulsants is $485.69 and the Cost per member for Pscyotheraputic drugs is $475.46

Conclusions The most utilized therapeutic drug class among the Ohio DODD Population is CNS Drugs Among the Ohio DODD Population, CNS Drugs are also the most costly in terms of Medicaid cost Cost per member Cost per patient prescribed

Conclusions The most utilized CNS Drugs among the Ohio DODD Population are Psychotherapeutic drugs and Anticonvulsants Among the Ohio DODD Population, Psychotherapeutic drugs and Anticonvulsants are also the most costly in terms of Cost per prescription Cost per patient Many people have seizure disorders

Limitations This analysis only includes claims information from the Ohio Department of Medicaid. It does not include private insurance, or those who are uninsured. Although someone was prescribed medicine, this analysis does not include data on if the medication was taken, and if the medication was taken properly or fully. There is no comparison to the general population.

Thank You If you have questions please contact us: Abby Hammond: Abby.Hammond@dodd.ohio.gov Hope McGonigle: Hope.Mcgonigle@dodd.ohio.gov Joslyn Tijerina: Joslyn.Tijerina@dodd.ohio.gov Arati Sharma: Arati.Sharma@dodd.ohio.gov