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TEXAS Health Care Data REPORT Introduction

contents HMOs Enrollment . . . . . . . . . . . . . . . . . . 3 Medical Utilization . . . . . . . . . . . . 4 Pharmacy Utilization . . . . . . . . . 5–6 Hospitals Utilization/Salary Costs . . . . . . . . 7 Medical Group Practices Demographics/Utilization . . . . . . 8 Pharmacy Services . . . . . . . . . . . 9 Diabetes Demographics . . . . . . . . . . . . . 10 Charges/Use of Services . . . . . 11 Pharmacotherapy . . . . . . . . 12–13

MA

CARE DIGEST ED G S A 1987

®

S INCE

IES ER

N

Retail Pharmacy Retail Drug Overview . . . . . . 14–15 Brand vs. Generic Utilization . . 16 Brand vs. Generic Spending . . 17 Drug Spending . . . . . . . . . . . . . 18 Out-of-Pocket Costs . . . . . . . . . 19

Provided by Sanofi US Bridgewater, NJ Developed and produced by Forte Information Resources LLC Denver, CO www.forteinformation.com Data provided by IMS Health Parsippany, NJ

www.managedcaredigest.com

contacts Rick Arce Rick.Arce@sanofi.com Senior Account Executive Sanofi US Dana McCormick Dana.McCormick@sanofi.com Area Medical Manager Sanofi US

Sanofi US and the Texas Association of Health Plans (TAHP) are pleased to present the Texas Health Care Data Report for 2013 (“Report”), an overview of ­demographic, financial, utilization and ­pharmacy measures for health plans, hospitals and ­medical group practices in key local markets across the state of Texas. The R ­ eport also provides Type 2 diabetes ­benchmarks and retail pharmacy utilization and spending data on several of the most widely prescribed therapeutic classes of drugs. Throughout the report, state and national benchmarks are included to help plans identify better opportunities to serve the needs of their members. The Report is designed to help TAHP fulfill its mission to improve health care delivery to the citizens of Texas and to promote communication within the managed care industry and among key components of the health care delivery system. The data in this report were gathered by IMS Health, Parsippany, NJ, a leading provider of innovative health care data products and analytic services. The data offer health plans with independent, thirdparty information they can use to benchmark their own data on patient demographics, professional and ­facility charges, utilization and pharmacotherapy. Sanofi US, as sponsor of this report, maintains an arm’s-length relationship with the organizations that prepare this report and carry out the research. The desire of Sanofi US is that the information in this report be completely independent and objective.

Methodology IMS Health gathered national-, state- and local-level data included in this Report from a variety of sources between February 2010 and June 2013, by contacting the state’s department of insurance, mailing a ­survey to each plan and following up, when necessary,

with a ­telephone or email survey. HMO data in this Report are from a census of health plans. When data were not available from all plans, a smaller sample was used. In addition, IMS Health compares its data with those published in other sources, including trade associations in the managed care i­ndustry, state regulatory agencies, and periodicals and journals. Doing so provides an additional check on the accuracy of its database of operating health plans. Hospital data for this report were gathered from state health licensing agencies, federal government sources and telephone or email surveys, and are effective as end-of-year 2011. IMS also provided national data about medical group practices with five or more full-time equivalent physicians. These data are effective as of midyear 2012. IMS Health also provided national data about medical group practices with five or more full-time equivalent physicians, totaling nearly 13,000 medical group practices nationwide. Data are effective as of July 2012. IMS Health generated Type 2 diabetes data for this Report out of health care professional and institutional insurance claims, representing more than 7.1 million unique Type 2 diabetes patients nationally in 2012 with a diagnosis in the 250.00–250.92 range. Data from physicians of all specialties and from all h ­ ospital types are included.

Retail pharmacy prescription metrics derive from IMS Health’s Vector One®: Payer (VOPA) platform. Through agreements with a variety of data providers, the IMS Health data warehouse receives billions of prescription claims per year. These data ­represent the sampling of prescription ­activity from a variety of sources, including retail chains, mass merchandisers and pharmacy benefit managers. Cash, mailorder, Medicaid and third-party transactions are tracked.

TAHP’s MISSION

To improve health care for all Texans by serving as an effective ­advocate for value, access, quality care, and sound public policy in the administration of health care benefits.

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TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


HMO: ENROLLMENT HMOs ACROSS TEXAS SHED MEMBERS IN 2012

AVERAGE NUMBER OF ENROLLEES PER PLAN, 2010–2012 MARKET

2010

2011

2012

Austin

161,736

174,985

168,359

Dallas

166,104

171,010

181,490

Ft. Worth

164,670

176,012

191,157

Houston

140,039

147,862

155,371

San Antonio

162,445

172,970

186,721

Texas

122,888

131,382

128,846

NATION

175,027

179,816

187,314

Coinciding with a decline in the total number of HMO members statewide, the number of enrollees per Texas HMO dipped between 2011 (131,382) and 2012 (128,846). However, such enrollment grew in four of the five local Texas markets shown.

TOTAL NUMBER OF HMO MEMBERS, TEXAS, 2003–20121 Medicare

Medicaid

Total 4,611.0

4,800 3,914.4

HMO Enrollment (000)

3,818.1

1,200

2,040.6

553.7 159.9

2003

989.2

1,280.1

1,339.1

1,583.8

1,691.8

864.0

899.4 231.1

268.3

300.8

393.2

407.3

416.9

501.3

533.2

196.0

2004

2005

2006

2007

2008

2009

2010

2011

2012

MEDICARE AND MEDICAID HMO ENROLLMENT, 20121 2,600

Medicare

Medicaid

2,429.2

Medicare ENROLLMENT GROWTH IN TX HMOs OUTPACES THAT OF NATION Between 2010 (416,932)

1,950 1,637.3 1,472.7

1,428.1

and 2012 (533,244), the

1,531.6

1,429.3

total number of Medicare

1,300

beneficiaries enrolled in

650 367.1

285.7

0

4,251.9

2,429.2

2,400

0

HMO Enrollment (000)

4,598.4 3,932.4

3,715.1

3,548.4

3,600

4,559.2

4,210.9

337.6

Texas HMOs surged by

533.2

428.4

27.9%, a notably faster

288.5

growth rate than that Austin

Dallas

Ft. Worth

Houston

San Antonio

Texas

of the nation (16.4%). All

Medicare HMO Medicaid HMO Nation: 8,624,740 26,862,854

told, the total number of government-funded enrollees in Texas plans

MEDICARE AND TOTAL GOVERNMENT ENROLLMENT IN HMOs Total Number of Medicare HMO Members

expanded by 39.9%

Total Number of HMO Government Enrollees1

between 2010 and 2012.

MARKET Texas

416,932

501,283

533,244

2,131,241

2,562,691

2,981,259

NATION

7,408,161

7,560,134

8,624,740

30,320,940

31,479,480

36,907,160

2010

2011

2012

2010

2011

2012

Data source: IMS Health © 2013 1

Medicaid and government enrollment counts exclude enrollees in the Children’s Health Insurance Plan (CHIP). The number of government enrollees includes Medicare Risk, Medicare Cost, Medicaid and Federal Employee Health Benefits Program (FEHBP) enrollees.

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

3


HMO/HOSPITAL MEDICAL UTILIZATION Admission counts fall, but hospital days rise per 1,000 texas hmo members

UTILIZATION RATES FOR COMMERCIAL HMO/POS MEMBERS1 Nation

Texas

Between 2011 and 2012, the

UTILIZATION RATE

2010

2011

2012

2010

2011

2012

number of hospital admissions

Hospital Admissions per 1,000 Members

49.8

47.9

45.7

58.7

57.4

58.4

215.1

201.3

206.0

238.2

235.9

239.1

ALOS per Hospital Admission

4.3

4.2

4.4

4.1

4.1

4.2

Physician Encounters per Member2

4.4

4.0

3.5

4.7

4.6

4.7

Ambulatory Visits per Member2

1.5

1.0

1.7

1.6

1.5

1.7

per 1,000 Texas HMO members declined by 4.6%, to

Hospital Days per 1,000 Members

45.7 from 47.9. By comparison, this admissions ratio rose slightly for HMOs nationwide, to 58.4 from 57.4. However, in concert with a 4.8% increase in average length of stay (ALOS) per hospital admission between 2011 and 2012,

Total Hospital Admissions per 1,000 HMO/POS Members, 2010–20121

hospital days per 1,000 HMO

Texas

60

members also expanded, to

Nation 58.7

In 2012, commercial members of Texas HMOs visited

Admissions/1,000 Members

Md Visits decline for commercial members of texas HMOs in 2012

58.4

57.4

206.0 from 201.3 the prior year.

physicians, on average,

55

49.8

50

47.9 45.7

45

40

3.5 times, a decrease from 4.0

2010

2011

2012

the prior year. In accordance with this decline, commercial

Total Hospital Days per 1,000 HMO/POS Members, 2010–20121

members enrolled in HMOs serving Texas saw physicians counterparts (4.7 visits) in 2012. Meanwhile, such members of Texas HMOs increased their number of ambulatory visits, to 1.7 from 1.0 the prior year, matching the national mark for 2012.

Hospital Days/1,000 Members

25.5% less than their national

280

Texas

Nation 238.2

210

215.1

239.0

235.9 206.0

201.3

140

70

0

2010

2011

2012 Data source: IMS Health © 2013

4 

1

All HMO utilization data exclude well baby, neonatal ICU and psychiatric patients.

2

Ambulatory visits differ from physician encounters. Ambulatory visits are visits by an HMO member to an HMO clinic or physician’s office that does not require the services of a physician. Such visits are usually made for tests, prescription refills, immunizations, etc. The term “physician encounter” is self-explanatory.

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


HMO PHARMACY UTILIZATION

PREMIUMS PER MEMBER PER MONTH FOR OUTPATIENT PHARMACY BENEFITS Individual Premiums MARKET

Family Premiums

2010

2011

2012

2010

Austin

$35.39

$40.92

$40.92

$89.10

$104.86

$104.86

Dallas

33.98

42.56

42.56

96.17

109.15

109.15

Texas markets (San Antonio

Ft. Worth

35.24

42.56

42.56

88.38

109.15

109.15

excepted), individual

Houston

35.24

42.56

42.56

88.38

109.15

109.15

premiums for outpatient

San Antonio

41.88

41.88

41.88

111.27

111.27

111.27

pharmacy benefits rose

Texas

36.99

41.73

41.73

90.92

103.89

103.89

$39.13

$39.97

$40.21

$97.60

$101.51

$101.80

NATION

2011

2012

Individual PHARMACY PREMIUMS INCREASE FOR TX HMO members In five of the six featured

between 2010 and 2012. Each Texas market also recorded premiums for such coverage that were higher than the U.S. mean in 2012. Statewide, individual

Individual Premiums per member per month for outpatient pharmacy benefits, 2008–2012 Texas

between 2010 ($36.99) $41.73

$42

Premium Cost ($) PMPM

premiums climbed 12.8%

Nation $41.73

and 2012 ($41.73). $40.21

$39.97 $39.13

$39 $37.49 $36.32

$36

$33

$33.23

Family Pharmacy Benefit Premiums Increase Across Tx, Top U.S. Mean

$36.99

Between 2010 and 2012,

$32.83

family premiums for $30

outpatient pharmacy 2008

2009

2010

2011

2012

benefits climbed at HMOs serving all but one of the Texas markets profiled.

Family Premiums per member per month for outpatient pharmacy benefits, 2008–2012 Texas

premiums increased

Nation $103.89

$104

Premium Cost ($) PMPM

Statewide, such family

$100.36

to $103.89 in 2012 from

$103.89 $101.51

$101.80

the national average of

$97.60

$98

$101.80. By local market,

$94.63

$92

$90.92

$90.92 in 2010, to top

family outpatient pharmacy

$90.92

benefit premiums were $86

lowest at HMOs serving the

$84.83

Austin market, at $104.86. $80

2008

2009

2010

2011

2012

Data source: IMS Health © 2013

NOTE: Throughout this Data Report, data are the same for some MSAs because the HMOs had the same service area. Data include all HMOs serving the state of Texas. In some cases, HMOs did not report their data.

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TEXAS Health Care Data REPORT 2013

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HMO PHARMACY UTILIZATION Retail RX UTILIZATION RATES FOR TX HMO MEMBERS Are Lower Than U.S. AVG.

PRESCRIPTIONS DISPENSED AND AVERAGE INGREDIENT COST RXs Dispensed per Commercial HMO Member per Year

Average Ingredient Cost1

MARKET

2010

2011

2012

2010

2011

2012

Austin

9.3

9.3

9.1

$70.85

$70.47

$66.56

Dallas

8.8

9.2

8.6

66.02

76.28

70.41

Ft. Worth

8.9

9.0

8.6

73.61

73.62

69.56

Houston

8.7

8.7

8.4

70.85

70.47

66.56

San Antonio

9.6

9.6

9.3

68.01

68.01

63.70

national average of 9.1

Texas

9.1

9.3

9.0

61.97

67.56

62.29

in 2012, to 9.0. In all five

NATION

9.3

9.4

9.1

$57.92

$58.95

$55.73

After rising slightly between 2010 (9.1) and 2011 (9.3), the number of prescriptions dispensed per Texas commercial HMO member dipped just below the

Texas local markets, such HMO members filled fewer prescriptions in 2012 than in

PRESCRIPTIONS DISPENSED PER COMMERCIAL HMO MEMBER PER YEAR

2011, with Dallas recording the largest proportional decline

10.0

2009

2010

2011

2012

Avg. Ingredient Cost Per RX for HMOs in TX Falls After Climb

Avg. Rxs/PMPY

(–6.5%), to 8.6 from 9.2. 9.5 9.2

9.3 9.1

9.2

9.4

9.3

9.1

9.0

9.0 8.5

Between 2009 ($57.16) 8.0

and 2011 ($67.56), the

Texas

Nation

average ingredient cost per prescription dispensed climbed 18.2% at HMOs serving the state of Texas.

AVERAGE INGREDIENT COST PER PRESCRIPTION DISPENSED1

However, in 2012, this measure In spite of this reduction, the average ingredient cost per HMO prescription in Texas in 2012 topped the national average—which itself declined to $55.73 from $58.95

$80

Avg. Ingredient Cost

declined by 7.8%, to $62.29.

2009

2010

2011

2012

$67.56

$65 $57.16

$62.29

$61.97

$54.04

$57.92

$58.95

$55.73

$50 $35 $20

Texas

Nation

the year before—by 11.8%.

Data source: IMS Health © 2013

1 This

average includes branded and generic drugs and is derived by dividing HMO pharmacy expenses by the total number of prescriptions dispensed. Expenses do not include administration and copayment costs.

6 

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


HOSPITAL UTILIZATION/Salary Costs SELECTED UTILIZATION STATISTICS FOR HOSPITALS, 20111 Austin

Brownsville

Dallas

Ft. Worth

3.7

4.4

4.4

3.9

5.2

Inpatient Surgeries/ Staffed Bed

15.8

14.7

16.5

19.1

Outpatient Surgeries per Day

8.9

8.4

11.1

64.5%

51.4%

63.3%

MEASURE Total Facility ALOS per Hospital

Outpatient Surgeries as a Percentage of Total Surgeries

San Antonio

Texas

NATION

4.3

4.2

4.4

4.8

16.0

15.4

21.6

13.3

11.9

11.8

12.3

8.5

10.4

8.7

10.3

64.4%

61.3%

Houston McAllen

TOTAL FACILITY ALOS FALLS SHY OF U.S. AVERAGE IN TX, BUT NOT IN HOUSTON Compared with the national average of 4.8 days, Texas hospitals recorded a lower total facility average length of stay (ALOS) in 2011. In fact, of the eight Texas markets profiled, only one (Houston, at

54.2%

54.8%

70.7%

66.4%

5.2 days) recorded a higher total facility ALOS than the U.S. mean that year. However, this measure increased

Total facility average length of stay (Days) per hospital 2010

Average Length of Stay (Days)

6

for hospitals in all but three 5.0

4

4.3 3.6

between 2010 and 2011

2011

4.4

4.3

Texas markets: Ft. Worth, San

5.2

4.4 4.0

3.7

4.2

3.9

4.3

—4.2—

—4.4—

—4.8—

3

Antonio and Texas as a whole.

Salary costs per fte are below the national mark at texas hospitals

2

Salary costs per full-time 0

Austin

Brownsville

Dallas

Ft. Worth

Houston

McAllen San Antonio

Texas

Nation

equivalent (FTE) were below the national mean at hospitals across the state of Texas in 2011 ($53,040 vs. $59,850). However, this

Salary costs per full-time equivalent for hospitals (in thousands), 2011

cost ratio exceeded the

Salary Costs/FTE (000)

$66

$62.4 $58.8

$60.7

$59.9

$60.3

$57

$55.9

$48

U.S. average in three of the featured Texas markets: Dallas

$53.0

($62,408), Ft. Worth ($60,670)

$46.7

and Houston ($60,294).

$39 $30

Austin

Brownsville

Dallas

Ft. Worth

Houston

McAllen

Texas

Nation

Data source: IMS Health © 2013

1  Total

facility figures reflect all portions of the hospital’s occupancy.

NOTE: Hospital utilization data represent patients of all payer types. Salary costs per FTE were unavailable for San Antonio.

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

7


DEMOGRAPHICS/UTILIZATION NUMBER OF MEDICAL GROUPS WITH FIVE OR MORE FTE PHYSICIANS, 2012 Austin

SIZE (# of MDs)

Brownsville

Dallas

Ft. Worth

Houston

McAllen

San Antonio

Texas

NATION

5–6

24

2

35

32

56

3

23

264

5,665

7–9

22

3

22

18

32

3

17

177

3,283 1,806

10–14

7

0

18

6

23

0

8

87

15–19

6

1

2

3

5

0

5

29

638

20+

5

1

9

3

13

0

4

68

1,545

64

7

86

62

129

6

57

625

12,937

Single Specialty

36

5

47

38

76

4

35

363

7,188

Multispecialty

28

2

39

24

53

2

22

262

5,749

TOTAL

64

7

86

62

129

6

57

625

12,937

TOTAL SPECIALTY COMPOSITION

Largest Share of Medical Groups in Texas HAve Five or Six Physicians in Texas with five or more full-time equivalent (FTE) physicians, 42.2% of the total had five or six FTE physicians in 2012—a share on par with the average across the U.S. that year (43.8%). Further, the

640

Number of Medical Groups

Of those medical groups

NUMBER OF MEDICAL GROUPS, BY NUMBER OF FTE PHYSICIANS, TEXAS 2011

628

2012

625

480

320

265

264 178

160

177 —87—

69

68

—29—

0

majority of Texas medical

5–6

7–9

10–14

15–19

20+

Total

groups were single specialty practices (363 of 625 total).

TX Groups Are Less Likely to Perform Surgery than Those Nationwide In 2012, 47.6% of medical groups in Texas performed surgeries, compared with the national benchmark of 54.7%. That year, 52.7% of Texas medical groups provided clinical labs (above the national average of 49.8%),

MEDICAL GROUP SERVICES Groups That Perform Surgery (%)

Groups That Have Clinical Labs (%)

MARKET

2011

2012

2011

2012

2011

2012

Austin

46.7%

48.3%

35.3%

36.7%

56.9%

55.4%

Brownsville

33.3

33.3

66.7

66.7

83.3

83.3

Dallas

49.4

49.4

48.4

48.4

67.6

67.6

Ft. Worth

63.5

63.5

52.9

52.9

62.8

62.8

Houston

46.1

46.1

54.1

54.1

66.3

66.3

McAllen

50.0

50.0

50.0

50.0

50.0

50.0

San Antonio

40.0

38.8

50.0

51.4

60.9

60.0

Texas

47.5

47.6

52.3

52.7

64.2

64.0

NATION

54.3%

54.7%

49.5%

49.8%

62.3%

64.5%

Data source: IMS Health © 2013

and 64.0% offered imaging services (nearly equivalent to the U.S. mean of 64.5%).

8 

Groups That Offer Imaging Services (%)

NOTE: IMS Health defines the medical groups represented in this Report as those with five or more FTE physicians whose primary business is seeing regularly scheduled patients for nonsurgical services other than imaging. Physicians must have a share in the practice and offer outpatient care, and the practice must be physically separate from a hospital. Anesthesiology and pathology groups are excluded.

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


PHARMACY SERVICES

MARKET

2011

2012

2011

2012

Share of TX Groups That Offer Pharmacy Services Lags U.S. Mean

Austin

47.1%

49.0%

52.9%

51.0%

Across the state of Texas,

Pharmacy Services Profile of Medical Group Practices Provide Pharmacy Services

Do Not Provide Pharmacy Services

Brownsville

50.0

50.0

50.0

50.0

a slight majority (52.2%) of

Dallas

49.2

49.2

50.8

50.8

medical groups with five or

Ft. Worth

57.1

57.1

42.9

42.9

more full-time equivalent (FTE) physicians provided

Houston

49.3

49.3

50.7

50.7

McAllen

100.0

100.0

0.0

0.0

pharmacy services to patients

San Antonio

35.1

36.1

64.9

63.9

in 2012, up slightly from 51.8%

Texas

51.8

52.2

48.2

47.8

in 2011. Nationally, 60.7% of

NATION

60.2%

60.7%

39.8%

39.3%

such medical groups provided pharmacy services, nearly

Percentage of Medical Groups

Medical Group Practices Providing Pharmacy Services, 2012

nine percentage points above the Texas average.

100.0%

100% 75% 50.0%

49.0%

50%

57.1%

Majority of Medical Groups Across TX Provide Rx Samples To Patients

49.3%

49.2%

36.1%

Although it trailed the national

25%

average of 75.0%, the majority

0%

Austin

Brownsville

Dallas

Ft. Worth

Houston

McAllen

(64.6%) of medical groups

San Antonio

that offered pharmacy

MEDICAL GROUP Practices, BY TYPE OF PHARMACY SERVICE1 Full Pharmacy

Limited Pharmacy

services across Texas provided

Samples

samples in 2012. In Ft. Worth,

MARKET

2011

2012

2011

2012

2011

2012

Austin

16.7%

16.7%

12.5%

12.5%

83.3%

83.3%

Brownsville

33.3

33.3

66.7

66.7

33.3

33.3

Dallas

26.7

26.7

6.7

6.7

70.0

70.0

of medical groups with

Ft. Worth

5.0

5.0

5.0

5.0

90.0

90.0

pharmacy services provided

Houston

33.3

36.1

8.3

8.3

63.9

61.1

prescription samples.

McAllen

16.7

16.7

16.7

16.7

66.7

66.7

San Antonio

61.5

61.5

7.7

7.7

38.5

38.5

Texas

26.4

26.9

13.7

13.7

65.1

64.6

NATION

18.7%

18.4%

10.0%

74.5%

75.0%

9.7%

where this measure was highest by market, 90.0%

1 Medical

groups with full pharmacies offer a complete range of medication types; those with limited pharmacy services offer a smaller range, often in particular therapeutic classes; others provide patients only with samples of medications.

MEDICAL GROUP Practices, BY TYPE OF PHARMACY SERVICE, 20121 Full Pharmacy

Percentage of Groups

92%

Limited Pharmacy

Samples 90.0%

83.3%

69%

70.0%

66.7%

46% 33.3%

23% 0%

16.7%

33.3%

61.5%

38.5%

36.1% 26.7% —16.7%—

12.5%

Austin

66.7%

61.1%

6.7%

Brownsville

Dallas

—5.0%—

Ft. Worth

8.3%

Houston

7.7%

McAllen

San Antonio

Data source: IMS Health © 2013

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

9


DIABETES: DEMOGRAPHICS One in Six Texas Type 2 diabetes patients has an A1c Level above 9.0%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1c LEVEL RANGE, 20121 MARKET

≤7.0%

7.1–7.9%

8.0–9.0%

>9.0%

Austin

46.7%

19.9%

13.6%

19.8%

In 2012, 16.2% of Texas Type 2

Brownsville

42.6

23.7

15.8

17.8

diabetes patients recorded

Dallas

55.6

18.2

12.0

14.2

an A1c level range above

Ft. Worth

58.9

18.5

10.9

11.8

9.0% on their latest test, a

Houston

51.5

19.8

12.4

16.3

percentage that exceeded

McAllen

41.1

21.3

16.2

21.4

the national benchmark

San Antonio

46.6

19.7

14.0

19.8

by 0.3 percentage points.

Texas

51.8

19.3

12.7

16.2

NATION

50.6%

20.6%

12.9%

15.9%

However, the percentages of such patients in this highest A1c level range exceeded 19% in Austin, McAllen and San Antonio in 2012.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY TYPE OF COMPLICATION, 20122 Rates of TX type 2 diabetes patients with Any of Three Complications top nation Compared with their national peers, Texas Type 2 diabetes patients were more prone to suffer from nephropathy (34.6% vs. 29.6%), neuropathy (33.2% vs. 31.3%) or hypoglycemia (7.5% vs. 7.3%) as a result of their Type 2

Cardiovascular Disease

Nephropathy

Neuropathy

Retinopathy

Austin

56.2%

33.1%

30.8%

10.5%

7.1%

Brownsville

38.5

25.1

28.5

38.3

5.0

Dallas

49.4

33.4

34.6

19.0

8.9

Ft. Worth

53.2

41.8

39.0

18.7

8.6

Houston

60.2

32.9

33.0

13.6

7.1

McAllen

55.5

35.0

35.2

31.3

5.0

San Antonio

51.6

50.3

33.6

13.4

6.4

Texas

55.7

34.6

33.2

16.4

7.5

NATION

58.1%

29.6%

31.3%

18.5%

7.3%

MARKET

Hypoglycemia

diabetes in 2012.

1

2

The A1c test measures the amount of glucose present in the blood during the past 2–3 months.

A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. These conditions are a direct result of having Type 2 diabetes. Complications of Type 2 diabetes include, but are not limited to, cardiovascular disease, hypoglycemia, nephropathy, neuropathy and retinopathy.

3

A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes. Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes. Comorbidities of Type 2 diabetes may include, but are not limited to, congestive heart failure, dysmetabolic syndrome, hyperlipidemia, ­hypertension and obesity.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY TYPE OF COMORBIDITY, 20123 Congestive Heart Failure

Hyperlipidemia

Austin

75.3%

73.8%

8.4%

9.1%

0.9%

Brownsville

77.7

53.3

9.6

8.9

Dallas

77.0

61.5

12.2

11.4

0.4

Ft. Worth

81.0

61.1

14.5

17.6

0.4

Houston

81.1

61.9

13.5

12.5

1.4

McAllen

82.8

60.4

15.8

9.2

0.6

San Antonio

83.8

57.3

11.7

10.0

0.4

Texas

80.0

62.0

13.0

11.3

0.7

NATION

79.6%

63.3%

12.3%

12.8%

0.8%

NOTE: On pages 10–13, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year.

Obesity

Dysmetabolic Syndrome

Hypertension

MARKET

Data source: IMS Health © 2013

Throughout this report, the Austin MSA includes San Marcos and the Ft. Worth MSA includes Arlington.

10 

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


DIABETES: CHARGES/USE OF SERVICES

Ambulatory Surgery Center

Emergency Room

Hospital Inpatient

Hospital Outpatient

Office/ Clinic

Texas Type 2 Diabetes Patients Record High Provider Charges

$2,370

$1,050

$2,280

$1,016

$1,800

In every setting profiled

Brownsville

2,890

1,565

1,670

1,027

2,201

in 2012, average annual

Dallas

2,517

1,269

3,197

1,363

2,268

professional charges for

Ft. Worth

3,041

1,294

4,683

1,375

2,744

the care of Type 2 diabetes

Houston

2,527

1,171

3,433

1,149

1,999

patients in Texas exceeded

McAllen

2,976

1,101

3,178

913

2,810

the national averages. Such

San Antonio

2,393

1,325

2,593

1,221

1,643

charges were highest, by

Texas

2,714

1,234

2,981

1,169

2,100

Texas market, in Ft. Worth for

$2,475

$946

$2,769

$1,096

$1,846

PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, 20121 MARKET Austin

NATION

four of five settings (office/ clinic excluded). Moreover, at $55,078, average annual inpatient facility charges for patients with Type 2 diabetes

FACILITY CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, 20122

in Texas topped the national

Hospital Inpatient

Hospital Outpatient

$41,887

$7,394

6,148

Dallas

51,473

9,793

Ft. Worth

44,703

4,069

TX Type 2 Diabetes Patients Have Low Testing Rates

Houston

57,275

9,344

With the exception of those

McAllen

64,588

7,254

in Austin, Type 2 diabetes

San Antonio

54,770

7,948

patients in the Texas markets

Texas

55,078

9,795

profiled were less likely than

$52,156

$10,647

MARKET Austin Brownsville

NATION

average of $52,156.

their peers nationally to receive an A1c test in 2012. Statewide, this measure (69.7%) was nearly five percentage points lower

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING VARIOUS SERVICES, 2012

than the national average

A1c Test3

Blood Glucose Test

Serum Cholesterol Test

Ophthalmologic Exam

Urine Microalbumin Test

Austin

78.0%

88.7%

85.4%

59.9%

65.6%

shown for Type 2 diabetes

Brownsville

61.3

83.0

79.1

68.9

61.5

patients in Texas were lower

Dallas

71.6

85.7

80.9

63.2

63.5

than the corresponding

Ft. Worth

66.6

81.8

78.0

64.4

60.9

national averages.

Houston

68.8

82.4

79.0

62.9

62.2

McAllen

71.4

85.6

82.2

68.1

67.2

San Antonio

66.1

83.0

77.9

62.7

62.4

Texas

69.7

84.1

80.2

63.6

62.9

NATION

74.1%

86.7%

84.4%

69.6%

71.5%

MARKET

Data source: IMS Health © 2013

M anaged C are D igest S eries®

of 74.1%. Indeed, testing rates for all five services

1

Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings.

2

Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care. The data also reflect the average amounts charged in Type 2 diabetes patient claims, not the amount the claims paid.

3

The A1c test measures the amount of glucose present in the blood during the past 2–3 months. Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year.

TEXAS Health Care Data REPORT 2013

11


DIABETES: PHARMACOTHERAPY LARGER PORTION OF TEXAS TYPE 2 DIABETES PATIENTS FILL INSULIN VS. NATION IN 2012

PERCENTAGE OF TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES, 2012

In each of the eight

MARKET

featured Texas markets,

Austin

the percentages of Type 2

Brownsville

Long-Acting Insulin

Any Insulin Products

Short-Acting Insulin

Rapid-Acting Insulin

IntermediateActing Insulin

Pens

Vials

Pens

Vials

Pens

Vials

Pens

Vials

39.1%

20.9%

11.8%

13.6%

10.5%

13.6%

8.9%

0.2%

1.1%

41.1

12.4

12.9

4.8

7.2

4.8

4.1

2.1

diabetes patients who filled

Dallas

34.7

14.5

9.2

8.2

9.0

8.2

6.1

0.3

1.7

prescriptions for any insulin

Ft. Worth

35.2

15.3

12.6

8.6

10.7

8.6

7.8

0.2

1.5

products topped the national

Houston

34.5

16.5

10.2

8.9

8.9

8.9

6.8

0.4

2.7

average of 33.9% in 2012.

McAllen

42.4

17.4

15.8

7.3

8.4

7.3

6.8

0.4

1.9

Type 2 diabetes patients in

San Antonio

39.7

18.9

13.0

11.4

8.9

11.4

7.2

0.8

2.3

McAllen were most likely,

Texas

36.4

16.3

11.7

9.0

9.6

9.0

7.2

0.3

2.0

by Texas market, to fill such

NATION

33.9%

15.3%

11.3%

9.2%

9.8%

9.2%

8.0%

0.3%

1.8%

prescriptions in 2012, at 42.4%, whereas just 34.5% of Houston Type 2 diabetes patients

AVERAGE ANNUAL PAYMENTS PER TYPE 2 DIABETES PATIENT USING INSULIN THERAPIES, 20121

received such prescriptions.

MARKET

PAYMENTS ARE RELATIVELY LOW FOR TX TYPE 2 PTS. who fill INSULIN products Texas patients with Type 2 diabetes who filled prescriptions for long-, shortor rapid-acting insulin pens or vials in 2012 paid less per year for their therapies than did similar patients across

Long-Acting Insulin

Any Insulin Products

Short-Acting Insulin

Rapid-Acting Insulin

IntermediateActing Insulin Pens

Vials

$798

$637

Pens

Vials

Pens

Vials

Pens

Vials

$2,248

$1,388

$1,226

$1,423

$1,499

$1,423

$1,520

Brownsville

2,124

1,338

1,289

1,135

886

1,135

1,257

849

Dallas

1,957

1,324

1,226

1,261

1,151

1,261

1,397

1,285

758

Ft. Worth

1,986

1,322

1,229

1,300

1,156

1,300

1,308

963

682

Houston

1,929

1,288

1,196

1,194

1,223

1,194

1,370

1,223

702

McAllen

1,948

1,287

1,194

1,094

1,030

1,904

1,175

1,345

746

San Antonio

1,999

1,245

1,093

1,434

1,133

1,434

1,219

933

698

Texas

1,986

1,307

1,215

1,264

1,185

1,264

1,325

1,218

726

$2,097

$1,334

$1,256

$1,303

$1,333

$1,303

$1,413

$1,164

$782

Austin

NATION

the nation that year. Dipeptidyl Peptidase 4 (DPP-4) Inhibitors Inhibit DPP-4 enzymes and slow inactivation of incretin hormones, helping to regulate glucose homeostasis through increased insulin release and decreased glucagon levels.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS USING NON-INSULIN ANTIDIABETIC THERAPIES, 2012 MARKET

Any Non-Insulin Antidiabetic Product %

$

%

$

%

$

%

$

%

$

GLP-1 Receptor Agonists  Used in conjunction with oral agents; increase glucose-dependent insulin secretion and pancreatic beta-cell sensitivity, reduce glucagon production, slow rate of absorption of glucose in the digestive tract by slowing gastric emptying, and suppress appetite.

Austin

82.2%

$955

27.9%

$92

8.8%

$1,618

13.0%

$1,515

8.6%

2,273

Brownsville

82.1

751

26.7

86

6.7

1,555

15.0

1,476

3.5

1,836

Dallas

83.8

757

32.9

78

6.9

1,576

11.8

1,427

6.1

1,913

Ft. Worth

83.2

730

32.2

74

7.0

1,536

12.4

1,471

5.0

1,704

Houston

85.5

784

32.6

79

7.2

1,499

12.8

1,403

7.2

1,794

McAllen

84.6

1,054

25.2

86

7.2

1,635

19.9

1,548

7.3

1,792

Insulin Sensitizing Agents Increases insulin sensitivity by improving response to insulin in liver, adipose tissue and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose.

San Antonio

82.7

842

31.2

77

9.4

1,506

14.0

1,410

7.3

1,800

Texas

83.8

798

31.8

79

7.5

1,549

13.0

1,442

6.6

1,845

NATION

84.6%

$745

34.4%

$89

7.1%

$1,650

12.8%

$1,525

4.9%

$1,964

Sulfonylureas  Stimulate the release of insulin in the pancreas.

12 

Sulfonylureas

Insulin Sensitizing Agents

DPP-4 Inhibitors

GLP–1 Receptor Agonists

Data source: IMS Health © 2013

1

Figures reflect the per-patient yearly costs for Type 2 diabetes patients receiving a particular type of therapy.

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®


PERSISTENCY: INSULIN THERAPIES, TEXAS, 2012 Long-Acting Insulin: Pens

Short-Acting Insulin: Pens

Rapid-Acting Insulin: Pens

Long-Acting Insulin: Vials

Short-Acting Insulin: Vials

Rapid-Acting Insulin: Vials

Percentage of Patients

100%

83%

66%

49%

32%

Mo. 1

Mo. 2

Mo. 3

Mo. 4

Mo. 5

Mo. 6

Mo. 7

Mo. 8

Mo. 9

Mo. 10

Mo. 11

Mo. 12

PERSISTENCY: NON-INSULIN ANTIDIABETIC THERAPIES, TEXAS, 2012 DPP-4 Inhibitors

GLP-1 Receptor Agonists

Insulin Sensitizing Agents

Percentage of Patients

100%

83%

66%

49%

32%

Mo. 1

Mo. 2

Mo. 3

Mo. 4

Mo. 5

Mo. 6

Mo. 7

Mo. 8

Mo. 9

Mo. 10

Mo. 11

Mo. 12

Readmissions READMISSION RATES FOR PATIENTS DIAGNOSED WITH TYPE 2 DIABETES, BY TYPE OF THERAPY, 2010–20121 3-Day Readmissions MARKET

Any Insulin Products

Texas

9.9%

30-Day Readmissions

READMIT RATES FOR TX TYPE 2 PATIENTS USING INSULIN ARE LOW VS. THREE ORALS

3 Non-Insulin Products

Any Insulin Products

3 Non-Insulin Products

12.6%

17.3%

22.4%

patients who were admitted

Of Texas Type 2 diabetes

Southwest Region

10.4

14.4

18.6

24.4

to inpatient facilities between

NATION

10.7%

14.4%

19.6%

25.0%

2010 and 2012, those who filled prescriptions for any

Data source: IMS Health © 2013

insulin products were less likely to be readmitted within three or 30 days than similar patients who filled three non-insulin antidiabetes products.

1

Figures reflect the percentages of Type 2 diabetes patients who were readmitted to an inpatient facility in the three-year period between 2010 and 2012. These percentages include patients who filled multiple prescriptions. Readmissions are not necessarily due to Type 2 diabetes.

NOTE: “Persistency” measures whether patients maintain their prescribed therapy. It is calculated by identifying patients who filled a prescription for the reported drug class in the four months prior to the reported year, and then tracking prescription fills for those same patients in each of the months in the current reported year. If patients fill a prescription in a month, they are reported among the patients who have continued or restarted on therapy. Continued means that the patient has filled the drug group in each of the preceding months. Restarted means that the patient did not fill in one or more of the preceding months. Continuing and restarting patients are reported together. All patients tracked are “New to Brand,” meaning they have not filled a prescription for their cohort product during the six months prior to initiation of therapy on that product.

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

13


RETAIL DRUG OVERVIEW Third Parties Cover Highest Number of Texas RXs in Five Drug Classes Third-party payers covered the largest number of retail prescriptions filled by patients in Texas, by payer, between midyear 2011 and midyear 2012. Patients in Texas covered by third parties filled the highest number of retail prescriptions among the five drug classes featured for antidepressants, at

TOTAL NUMBER OF RXs (IN MILLIONS), BY PAYER, 20121 DRUG CLASS

TOTAL

Third Party

Medicare Part D

Medicaid

Cash

3.0 40.4

0.1 2.6

1.4 14.3

0.2 2.9

4.7 60.1

1.1 15.6

0.7 13.0

0.8 11.1

0.1 1.3

2.7 41.1

4.9 74.3

1.3 26.6

2.4 24.2

0.4 4.0

8.9 129.1

8.6 153.3

2.2 45.0

0.8 22.3

1.0 18.6

12.7 239.2

6.3 88.1

3.0 45.9

0.5 11.4

0.6 10.7

10.4 156.1

ADHD Texas NATION

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

DIABETES Texas NATION

8.6 million—nearly quadruple that of the Medicare Part D

TOTAL RX SPENDING (IN MILLIONS) PER YEAR, BY PAYER, 20121, 2

total (2.2 million). Meanwhile,

DRUG CLASS

Medicaid covered 2.4 million

ADHD

asthma prescriptions for patients across Texas, nearly 10% of the national number of Medicaid asthma prescriptions dispensed (24.2 million).

Texas NATION

Third Party

Medicare Part D

Medicaid

Cash

TOTAL

$532.5 6,643.1

$22.8 521.3

$256.3 2,303.9

$33.4 357.2

$845.0 9,825.5

$343.1 4,744.2

$288.7 4,422.2

$356.4 3,746.9

$25.3 312.5

$1,013.5 13,225.8

$651.3 9,724.0

$236.8 4,513.9

$330.2 2,793.3

$32.3 389.8

$1,250.5 17,420.9

$530.2 7,370.7

$133.6 2,175.4

$57.6 897.2

$37.5 863.9

$758.9 11,307.2

$757.6 9,764.5

$389.6 5,291.2

$73.9 1,263.8

$34.2 465.6

$1,255.2 16,785.1

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION

Texas Medicaid RX Spending Is Highest for Antipsychotics For patients receiving Medicaid in Texas, total

Texas NATION

DIABETES Texas NATION

retail prescription spending between midyear 2011 and midyear 2012 was highest by drug class for antipsychotics, at $356.4 million. Such spending for antipsychotic prescriptions for Texas patients was higher than that of all three other payers and accounted for 35.2% of the Texas total ($1.0 billion).

1

Data are as of midyear 2012, and represent the numbers/percentages of prescriptions dispensed, by drug class, to all patients.

2

The total full price the pharmacy charges the patient for the product, regardless of copayment situation.

14 

SHARE OF TOTAL RXs DISPENSED, BY PAYER, 20121 DRUG CLASS

Third Party

Medicare Part D

Medicaid

Cash

ADHD Texas NATION

64.1% 67.2

1.9% 4.3

29.1% 23.7

4.9% 4.7

40.1% 38.1

27.0% 31.7

29.3% 27.1

3.6% 3.1

54.7% 57.6

14.6% 20.6

26.6% 18.7

4.2% 3.1

68.0% 64.1

17.1% 18.8

6.6% 9.3

8.3% 7.8

60.7% 56.4

28.9% 29.4

4.5% 7.3

6.0% 6.9

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

DIABETES Texas NATION

TEXAS Health Care Data REPORT 2013

Data source: IMS Health © 2013

M anaged C are D igest S eries®


SHARE OF TOTAL RXs IN EACH PAYER TYPE, BY AGE, 20121 Third Party

DRUG CLASS

Medicare Part D

0–24

25–44

45–64

65+

55.8% 55.5

28.2% 26.9

15.0% 16.3

25.9% 23.7

28.3% 27.2

35.0% 30.2

Medicaid

0–24

25–44

45–64

65+

0–24

25–44

45–64

1.0% 1.2

13.5% 22.3

27.1% 27.1

36.8% 33.6

22.7% 16.9

97.0% 90.1

2.0% 7.5

1.0% 2.4

34.2% 37.6

11.6% 11.5

2.0% 2.3

26.6% 26.4

44.4% 46.2

27.1% 25.1

53.6% 38.1

23.3% 30.3

18.0% 18.0

32.4% 35.1

14.5% 16.6

1.1% 2.6

4.3% 5.8

22.7% 26.5

71.9% 65.0

86.2% 59.5

8.3% 9.4

33.5% 31.9

48.1% 48.6

10.1% 10.2

0.6% 1.2

9.7% 11.9

31.0% 33.8

58.7% 53.1

2.5% 2.9

15.9% 13.9

62.2% 59.9

19.4% 23.4

0.1% 0.2

2.9% 3.6

21.7% 23.0

75.3% 73.2

Cash 65+

0–24

25–44

45–64

65+

0.0% 0.0

32.4% 27.8

46.4% 46.9

18.5% 21.9

2.7% 3.4

22.7% 30.7

0.2% 1.0

16.3% 16.7

32.0% 30.6

30.3% 33.9

21.5% 18.7

4.0% 14.0

9.4% 24.6

0.2% 1.9

27.7% 23.2

20.2% 19.4

25.0% 28.5

27.1% 28.8

39.1% 21.8

25.7% 37.7

34.4% 38.5

0.8% 2.0

9.0% 10.1

37.9% 34.4

41.7% 43.5

11.3% 12.0

15.2% 8.5

21.0% 22.7

60.7% 60.6

3.1% 8.1

5.9% 4.5

18.0% 13.2

54.0% 53.5

22.0% 28.9

ADHD Texas NATION

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

DIABETES Texas NATION

TX Retail Diabetes Rx Share Dispensed to Patients Aged 45–64 Is High

SHARE OF TOTAL RXs DISPENSED, BY AGE, 20121 0–24

Share of Total Prescriptions Dispensed

100%

75%

1.2%

1.7%

11.5%

14.1%

21.4%

23.3%

13.2%

12.8%

38.4%

65+

17.9%

17.5%

diabetes prescriptions

35.0%

37.3%

43.8%

between the ages of 45

44.4%

and 64—the largest share,

12.4% 26.5% 65.9%

43.4% 27.2%

Nation

ADHD

Texas

Nation

and higher than the national 29.3%

28.9%

9.1%

9.1%

average of 48.6%.

Texas

Antipsychotic

Nation

Asthma

Texas

Nation

12.5% 2.6%

Texas

Depression

11.4%

Share of Total Prescriptions Dispensed

Male

Diabetes

profiled, retail prescriptions were more likely to be

69.7%

dispensed to females than 58.7%

57.1%

57.1% 52.7% 47.3%

44%

Across TX, Retail RXs in Four of Five Classes Are More Likely Filled by Females For four of five drug classes

Female 70.7%

2.6%

Nation

SHARE OF TOTAL RXs DISPENSED, BY GENDER, 20121 78%

by age, for this drug class

48.6%

29.8%

20.6%

0% Texas

50.0%

14.7%

27.9%

61.0%

25%

61%

were dispensed to patients

24.6% 31.2%

50%

45–64

Across Texas, half of retail

19.6% 24.1%

33.5%

25–44

53.0% 47.0%

42.9%

41.3%

50.6%

53.4% 49.4%

46.6%

51.1% 48.9%

males in Texas between midyear 2011 and midyear 2012. This discrepancy was

42.9%

greatest for depression 30.3%

29.3%

27%

prescriptions in Texas—70.7% of such prescriptions were filled by female

10%

Texas

Nation

ADHD

Texas

Nation

Antipsychotic

Texas

Nation

Asthma

Texas

Nation

Depression

Texas

Nation

Diabetes

patients over the period, one percentage point

Data source: IMS Health © 2013

above the corresponding

1

U.S. average (69.7%).

Data are as of midyear 2012, and represent the numbers/percentages of prescriptions dispensed, by drug class, to all patients.

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

15


BRAND VS. GENERIC UTILIZATION Generic Drug Shares in Texas Climb for Four of Five Classes The generic shares of total retail prescriptions climbed in Texas for four of five drug

OVERALL SHARE OF RXs FILLED WITH GENERIC DRUGS, 2010–20121 DRUG CLASS Texas NATION Texas NATION Texas NATION

asthma prescriptions, the

DEPRESSION

single exception, waned

Texas NATION

from 17.0%). The largest

2012

28.8% 35.2

28.9% 38.2

40.6% 53.0

27.6% 32.3

28.6% 33.1

39.9% 44.9

17.0% 13.5

15.9% 14.4

16.3% 14.4

57.8% 61.3

64.1% 67.5

70.9% 72.4

ASTHMA

2012. The generic share of

over the period (to 16.3%

2011

ANTIPSYCHOTIC

classes shown between midyear 2010 and midyear

2010

ADHD

DIABETES

increase in Texas, by drug

Texas

53.4%

55.6%

56.6%

NATION

56.7

59.0

60.1

class, was for generic depression prescriptions,

OVERALL SHARE OF RXs FILLED WITH GENERIC DRUGS, 20121

the share of which grew 80%

by 13.1 percentage points Nationally, the generic shares of retail prescriptions grew between midyear 2010 and midyear 2012 for all five drug classes profiled.

TX Generic RX Shares in Four of Five Classes Are Below National Averages

Nation

60%

40%

44.9%

40.6%

39.9%

20%

0%

16.3%

ADHD

Antipsychotic

between midyear 2011 and midyear 2012 was lower in Texas than the corresponding national benchmarks. This differential was greatest for ADHD prescriptions: the generic drug share for Texas patients was 40.6% versus 53.0% nationally.

1

Data are as of midyear 2012, and represent the numbers/percentages of prescriptions dispensed, by drug class, to all patients.

16 

14.4%

Asthma

Depression

Diabetes

SHARE OF TOTAL RXs DISPENSED, BY PAYER, 20121

shown (asthma excepted), filled with generic drugs

60.1%

56.6%

53.0%

For four of five drug classes the share of retail prescriptions

72.4%

70.9%

Percentage of Prescriptions

(to 70.9% from 57.8%).

Texas

Third Party

DRUG CLASS

Medicare Part D

Medicaid

Cash

Brand

Generic

Brand

Generic

Brand

Generic

Brand

Generic

55.0% 44.7

45.0% 55.3

40.3% 33.2

59.7% 66.8

75.8% 61.0

24.2% 39.0

28.0% 21.7

72.0% 78.3

61.6% 57.7

38.4% 42.3

55.2% 51.2

44.8% 48.8

63.8% 57.1

36.2% 42.9

50.5% 44.0

49.5% 56.0

85.3% 85.9

14.7% 14.1

90.2% 91.3

9.8% 8.7

79.4% 81.2

20.6% 18.8

67.6% 69.8

32.4% 30.2

30.5% 28.4

69.5% 71.6

25.8% 24.9

74.2% 75.1

32.6% 26.3

67.4% 73.7

21.5% 28.9

78.5% 71.1

44.4% 40.6

55.6% 59.4

44.1% 42.5

55.9% 57.5

55.5% 47.2

44.5% 52.8

21.2% 15.3

78.8% 84.7

ADHD Texas NATION

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

DIABETES Texas NATION

TEXAS Health Care Data REPORT 2013

Data source: IMS Health © 2013

M anaged C are D igest S eries®


BRAND VS. GENERIC SPENDING TOTAL RX SPENDING (IN MILLIONS) PER YEAR FOR BRAND NAME RXs, BY PAYER, 20121, 2 Third Party

Medicare Part D

Medicaid

Cash

TOTAL

$363.4 4,078.6

$17.5 352.6

$208.9 1,652.5

$15.2 140.0

$605.0 6,223.7

Texas

$308.3

$250.7

$340.2

$21.3

NATION ASTHMA

4,170.1

3,673.4

3,366.1

319.0

$920.5 11,451.1

Texas

$607.4 9,098.3

$231.0 4,419.6

$296.6 2,543.8

$26.5 241.4

$1,161.5 16,380.7

Texas

$384.8

$97.3

$45.7

$20.9

NATION DIABETES

4,819.1

1,418.3

611.9

454.1

$548.7 7,303.5

DRUG CLASS ADHD Texas

NATION ANTIPSYCHOTIC

Diabetes Rxs Have Highest Brand Name Spending for Two Payers in Texas For Medicare Part D ($360.0 million) and third-party payers ($708.2 million) alike, total drug spending for brand name prescriptions

NATION DEPRESSION

Texas

NATION

$708.2

$360.0

$70.8

$25.4

9,094.0

4,876.0

1,191.6

280.5

was highest for diabetes drugs in the 12 months ending at midyear 2012. For Medicaid, brand name drug spending was highest for

$1,164.4 15,442.1

antipsychotic prescriptions, at $340.2 million. Meanwhile, total drug spending for

TOTAL RX SPENDING (IN MILLIONS) PER YEAR FOR GENERIC RXs, BY PAYER, 20121, 2 Third Party

Medicare Part D

Medicaid

Cash

TOTAL

$169.1 2,564.4

$5.3 168.7

$47.4 651.4

$18.2 217.2

$240.0 3,601.8

$34.9 574.1

$38.0 748.8

$16.2 380.8

$3.9 71.1

$93.0 1,774.8

$43.9 625.7

$5.8 94.3

$33.5 249.4

$5.8 70.8

$89.0 1,040.3

Texas

$145.4

$36.3

$11.9

$16.7

NATION DIABETES

2,551.6

757.0

285.3

409.7

$210.3 4,003.7

Texas NATION

$49.4 670.6

$29.6 415.2

$3.1 72.2

$8.7 185.1

$90.8 1,343.0

DRUG CLASS

brand name ADHD drugs in Texas accounted for nearly

ADHD Texas NATION

10% of the national total.

ANTIPSYCHOTIC Texas NATION

ADHD Tops Classes for Third-Party and Medicaid Generic Rx Spending

ASTHMA Texas NATION

Between midyear 2011 and

DEPRESSION

midyear 2012, third-party payers reported the highest spending for generic drugs in Texas in the ADHD drug class, at $169.1 million—70.5% of the total for all payers ($240.0 million). Generic

TOTAL RX SPENDING (IN MILLIONS) PER YEAR, BRAND NAME VS. GENERIC DRUGS, Texas, 20121,2

Prescription Spending ($ Millions)

$1,200

Brand

Generic

drug spending was likewise highest in this class for

$1,164

$1,162

Medicaid recipients in Texas. By comparison, Medicare

$921

Part D spending in Texas

$800

was highest for generic

$605

$549

antipsychotic prescriptions that year ($38.0 million).

$400 $240

$210 $93

$0

ADHD

Antipsychotic

Data source: IMS Health © 2013

M anaged C are D igest S eries®

$91

$89

Asthma

Depression

1

Diabetes

Data are as of midyear 2012, and represent the numbers/percentages of prescriptions dispensed, by drug class, to all patients.

2

The total full price the pharmacy charges the patient for the product, regardless of copayment situation.

TEXAS Health Care Data REPORT 2013

17


DRUG SPENDING Rx Spending PPPY in Texas Tops National Averages for four drug classes Total retail spending per patient per year (PPPY) for prescriptions dispensed between midyear 2011 and midyear 2012 was higher in Texas than the corresponding national means for four of five drug classes (depression

TOTAL RX UTILIZATION AND SPENDING, 20121 DRUG CLASS

Total Retail $ per Patient per Year2

294.3 255.9

$52.54 41.86

169.8 174.9

$63.01 56.34

554.7 549.8

$77.75 74.21

788.6 1,019.0

$47.18 48.17

648.8 665.0

$78.04 71.50

ADHD Texas NATION

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

excepted). For instance,

DIABETES

patients in Texas paid an

Texas NATION

average of $78.04 per year

Total Retail Rxs per 1,000 Patients

for diabetes prescriptions over the period, 9.1% higher than the U.S. benchmark of $71.50.

TOTAL NUMBER OF RXs PER 1,000 PATIENTS, BY PAYER, 20121 DRUG CLASS

Third Party

Medicare Part D

Medicaid

Cash

TOTAL

ADHD

RX Spending PPPY Is Highest in Three Classes for Medicaid Patients in Tx In three of five drug classes (ADHD, antipsychotic, and asthma medications) Medicaid recorded the

Texas NATION

69.1 106.2

971.9 728.9

40.5 41.4

294.3 255.9

143.3 128.2

564.1 538.6

564.0 568.5

17.2 18.3

169.8 174.9

638.5 608.7

995.4 1,098.6

1,670.5 1,235.2

64.8 58.6

554.7 549.8

1,128.3 1,256.1

1,658.4 1,859.7

593.1 1,142.3

183.5 269.5

788.6 1,019.0

828.5 721.7

2,303.6 1,897.3

329.1 582.9

108.9 155.7

648.8 665.0

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas

NATION DEPRESSION Texas

highest retail spending per

NATION DIABETES

patient per year between

Texas

midyear 2011 and midyear

397.1 331.0

NATION

2012. Such payments were highest for Medicaid patients

TOTAL RX SPENDING PER PATIENT PER YEAR, BY PAYER, 20121, 2

receiving antipsychotic

DRUG CLASS

prescriptions, which, at

ADHD

$251.29 were 14.0% higher than Medicare Part D spending in this category ($220.48 per patient per year) and 4.6 times that of third-party payers ($44.91).

Texas NATION

Data are as of midyear 2012, and represent the numbers and costs of prescriptions dispensed, by drug class, to all patients.

2

The total full price the pharmacy charges the patient for the product, regardless of copayment situation.

18 

Medicare Part D

Medicaid

Cash

TOTAL

$69.69 54.43

$17.42 21.56

$180.73 117.76

$5.84 5.18

$52.54 41.86

$44.91 38.87

$220.48 182.89

$251.29 191.51

$4.42 4.53

$63.01 56.34

$85.24 79.68

$180.79 186.68

$232.81 142.77

$5.65 5.65

$77.75 74.21

$69.39 60.39

$102.01 89.97

$40.63 45.86

$6.57 12.53

$47.18 48.17

$99.14 80.01

$297.53 218.83

$52.09 64.60

$5.98 6.75

$78.04 71.50

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

1

Third Party

DIABETES Texas NATION

TEXAS Health Care Data REPORT 2013

Data source: IMS Health © 2013

M anaged C are D igest S eries®


OUT-OF-POCKET COSTS OOP Costs Per RX in Texas Top National Averages

AVERAGE OUT-OF-POCKET COSTS PER RX, 20121

At midyear 2012,

$41.63

ADHD $33.91

out-of-pocket (OOP) costs $43.51

Antipsychotic

per retail prescription in all

$32.30

five drug classes shown were

$33.33

Asthma

higher in Texas than across

$29.31 $21.84

Depression

$25.74

Diabetes

$20

were highest, by profiled drug class, for antipsychotic drugs,

Nation

$22.30

$10

the U.S. Such Texas costs

Texas

$17.80

at $43.51 per prescription, $30 Out-of-Pocket Costs

$40

$50

34.7% higher than the national benchmark ($32.30).

AVERAGE OUT-OF-POCKET COSTS PER RX, BY PAYER TYPE, 2010–20121 Third Party

Medicare Part D

Cash

2010

2011

2012

2010

2011

2012

$39.16 33.70

$38.74 32.92

$38.44 32.43

$29.91 23.56

$20.15 17.15

$18.30 16.43

$112.54 95.91

$128.38 102.13

$139.02 116.30

Texas

$47.18

$46.06

$45.13

$32.03

$18.07

$14.56

$255.60

$236.21

$247.52

NATION ASTHMA

40.23

39.36

38.32

22.43

14.84

12.67

203.03

211.38

240.64

Texas

$32.98 29.82

$33.13 30.22

$34.75 31.80

$29.43 25.82

$24.28 23.33

$22.41 22.28

$85.90 75.27

$81.36 78.03

$88.20 91.35

DRUG CLASS

2010

2011

2012

ADHD Texas

NATION ANTIPSYCHOTIC

NATION DEPRESSION Texas

$22.57

$22.71

$22.87

$13.87

$11.15

$10.20

$52.84

$39.45

$37.82

NATION DIABETES

18.64

17.99

17.39

11.63

9.66

9.09

39.37

40.31

47.61

Texas

$25.54

$26.39

$27.29

$19.66

$16.70

$15.98

$65.02

$52.68

$57.73

22.32

23.57

24.08

18.45

17.12

16.32

43.42

41.31

45.17

NATION

% CHANGE IN AVERAGE OUT-OF-POCKET COSTS PER RX, BY PAYER, 2010–20121 DRUG CLASS

Third Party

Medicare Part D

Cash

ALL PAYERS

–1.8% –3.8

–38.8% –30.3

23.5% 21.3

–7.6% –6.9

–4.3% –4.7

–54.5% –43.5

–3.2% 18.5

–24.4% –16.1

5.4% 6.6

–23.9% –13.7

2.7% 21.4

–6.6% –0.6

1.3% –6.7

–26.5% –21.8

–28.4% 20.9

–9.7% –4.6

6.9% 7.9

–18.7% –11.5

–11.2% 4.0

–5.7% 0.8

ADHD Texas NATION

ANTIPSYCHOTIC Texas NATION

ASTHMA Texas NATION

DEPRESSION Texas NATION

DIABETES Texas NATION

Texas Records Decline in OOP Costs for Rxs in Five Drug Categories Overall OOP costs per prescription declined in Texas for all five major drug classes shown between midyear 2010 and midyear 2012. Although they remained higher than the national average (see above), antipsychotic prescriptions in Texas recorded the largest OOP cost decline over the period (24.4%).

Data source: IMS Health © 2013

1

Data are as of midyear 2012, and represent the costs of prescriptions dispensed, by drug class, to all patients.

NOTE: “Out-of-pocket cost” is the actual amount paid by the patient for the individual prescription. This cost mainly includes copayments, but can also include tax, deductibles and cost differentials where applicable.

M anaged C are D igest S eries®

TEXAS Health Care Data REPORT 2013

19


Texas Association of Health Plans 1001 Congress Avenue, Suite 300 Austin, TX 78701 Phone: 512.476.2091 Fax: 512.476.2870 www.tahp.org

TEXAS Health Care Data REPORT 2013 Sanofi is pleased to bring you the fifth edition of the Texas Health Care Data Report. The report features key national-, state- and local-level data on Type 2 diabetes, HMOs, medical groups, hospitals and retail prescriptions from the Sanofi Managed Care Digest Series . ®

n

Demographics

n

Charges/Use of Services

n

Pharmacotherapy

n

HMO Enrollment

n

HMO Medical and Pharmacy Utilization

n

Medical Groups

n

Hospital Utilization

n

Retail Pharmacy

© 2013 sanofi-aventis U.S. LLC, A SANOFI COMPANY US.NMH.13.07.003

20 

TEXAS Health Care Data REPORT 2013

M anaged C are D igest S eries®

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2013 Texas Health Care Data Report