Minimal impact expected to private drug plans following switch from OxyContin to OxyNEO

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Effective March 1, 2012 Purdue Pharma withdrew OxyContin from the market and launched their new product OxyNEO. Many provinces are discontinuing coverage for controlled-release oxycodone (OxyContin®) used to treat moderate to severe pain and will consider only exceptional case-by-case coverage of the new product, OxyNEO®. Both products contain the active ingredient oxycodone in a controlled release formulation. Although the active ingredients are the same, the OxyNEO tablet is manufactured differently and is reportedly more tamper-resistant than OxyContin. OxyNEO is reportedly more difficult to crush and when added to water it forms a thick gel-like substance. Recent studies  have suggested that increased rates of opioid prescribing, particularly involving long acting oxycodone have contributed significantly to opioid-related harms, including hundreds of deaths in Ontario. Issues identified in these studies include excessive prescribing, increasing misuse, diversion of drugs away from intended medical purposes, increases in addiction, and increases in opioid-related deaths.1

The ministry initiated a third party review of the Ontario Drug Benefit (ODB) claims data to look at the use of oxycodone long acting tablets.  The results of the study were concerning because of the high number of patients who: started on long acting oxycodone after only trying short acting narcotics; or are being started on long acting oxycodone as an initial treatment. The current funding criteria require patients to start on another long acting opioid first before starting on long acting oxycodone due to concerns about inappropriate use.1

What is Ontario doing?

The changes will affect Ontario Drug Benefit recipients as follows:

  • For existing ODB recipients currently receiving OxyContin:
    • ODB recipients who have had a claim submitted to the ODB program for OxyContin within the past six (6) months will receive automatic coverage for OxyContin for a one (1) month period from February 29, 2012 to April 2, 2012, subject to availability of supply at the pharmacies.
    • After April 2, 2012, if the doctor determines that OxyNEO is appropriate, the patient will continue to receive automatic coverage for OxyNEO (10mg, 15mg, 20mg, 30mg, 40mg and 80mg) for a period of one year.  This coverage will end on February 28, 2013.
    • If coverage for OxyNEO is required beyond February 28, 2013, the physician must apply for an Exceptional Access Program (EAP) approval.
  • For all other ODB recipients requiring OxyNEO, the following process will apply:
    • for patients with chronic pain, OxyNEO (10mg, 15mg, 20mg, 30mg and 40mg tablets) will be considered through the EAP according to specific criteria.
    • for cancer patients or palliative care patients, OxyNEO (10mg, 15mg, 20mg, 30mg, 40mg and 80mg tablets) will be considered for funding according to the specific criteria through the Palliative Care Facilitated Access List for whom the prescriber is registered.  If the prescriber is not registered on the Palliative Care Facilitated Access List, a request for funding of OxyNEO must be made through the EAP process1

What is Saskatchewan doing?

Starting February 29, 2012, the Saskatchewan Drug Plan will list OxyNEO under the Exception Drug Status program. Cancer or palliative pain patients will receive coverage for OxyNEO under this program. New patients who do not meet these criteria will be responsible for the full cost of an OxyNEO prescription. Existing patients who have received coverage of OxyContin in the three months prior to March 1, 2012, will be eligible for coverage of OxyNEO.  OxyNEO is not interchangeable with OxyContin. Saskatchewan Drug Plan beneficiaries changing to OxyNEO will require a new prescription if their physician considers it appropriate.2

What are the Atlantic Provinces doing?

The Atlantic Expert Advisory Committee, an independent advisory group composed of physicians, pharmacists and other drug therapy and drug use experts, has reviewed OxyNEO and recommended that it not be listed on the Nova Scotia Pharmacare formulary. New Brunswick, Prince Edward Island and Newfoundland and Labrador have also restricted access to the drug. As of March 1, 2012, requests for new prescriptions for OxyContin or OxyNEO will not be covered by provincial Pharmacare. OxyNEO will only be covered for patients already receiving prescriptions for OxyContin. The program will consider requests for OxyNEO on a case-by-case basis for cancer or palliative pain when other alternatives have failed or are not appropriate.  OxyNEO is not interchangeable with OxyContin. Nova Scotia Pharmacare beneficiaries changing to OxyNEO will require a new prescription if their physician decides it is appropriate for them to continue. Existing part-fill OxyContin prescriptions, which are filled in stages, will have to be rewritten for OxyNEO once the supply of OxyContin is depleted.3

What is British Columbia doing?

Effective March 8, 2012, Pharmacare is discontinuing coverage for OxyContin and will consider only exceptional case-by-case coverage of the new product, OxyNEO. This follows the manufacturer’s decision to discontinue production of OxyContin and market the new product, OxyNEO.

  • For patients with current annual Special Authority approval for OxyContin, Pharmacare will continue to cover OxyContin and OxyNEO until their Special Authority approval ends. After reassessment and if still appropriate, physicians may request exceptional coverage by providing supporting rationale in a letter to Special Authority.
  • Patients with indefinite Special Authority approval will be granted transitional coverage until February 28, 2013, for OxyContin and OxyNEO to allow time for physicians to reassess the appropriateness of the patient’s pain management.
  • Palliative care patients will continue to receive coverage for OxyContin and OxyNEO through Pharmacare Plan P.

Pharmacare encourages physicians to work with their patients to reassess the appropriateness of pain management. For patients continuing on controlled-release oxycodone with OxyNEO, a new prescription will have to meet the requirements for controlled drug products. The B.C. College of Physicians and Surgeons’ Duplicate Prescription Program and Prescription Review Program ensure that drugs like OxyContin are securely and appropriately prescribed.4

What is Manitoba doing?

Effective March 26, 2010, Manitoba Pharmacare changed the benefit status of OxyContin and its generic equivalent drugs. These drugs have moved from Part 1 benefit status to Part 3 Exception Drug Status (EDS).

What is Quebec doing?

Under very specific circumstances, pharmacists have been given the authority to interchange OxyContin for OxyNEO without the need for a new prescription. At this time, RAMQ has not yet added OxyNEO to its provincial formulary and expects to review the drug in June of 2012.

What about the others?

Alberta still lists OxyNEO as a regular benefit under its provincial plan.

What does this mean for Sun Life’s plan sponsors?

Using Telus data from 2011, OxyContin use was analyzed for our entire block of business. The results show that OxyContin use makes 0.05% (or approximately 10,000 claimants). Although volumes may increase due to changes in government funding of OxyNEO, it is unlikely that it will result in a huge impact to overall drug spend. It’s our belief that, with all the changes that are occurring, prescribers are not going to prescribe OxyNEO as freely as they have in the past with OxyContin. Government initiatives like the Ontario Narcotic Strategy are put in place for that very reason.  Second to that, Ontario is the largest consumer of OxyContin compared to the other provinces. Ontario makes up 75% of OxyContin Claims and DIN Cost as well as 74% of Claimants.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.

References:

1.       http://www.health.gov.on.ca/en/public/programs/drugs/ons/oxy_faq.aspx      

2.       http://www.gov.sk.ca/

3.       http://www.gov.ns.ca/news/details.asp?id=20120221003

4.       http://www.health.gov.bc.ca/pharmacare/newsletter/news12-004.pdf