How has the opioid crisis affected people with employer coverage?


This collection of charts complements our brief, “A look at how the opioid crisis has affected people with employer coverage,” which uses claims data from large employers to examine how the opioid crisis has affected people with large employer coverage, including employees and their dependents. The analysis is based on a sample of health benefit claims from the Truven MarketScan Commercial Claims and Encounters Database, which we used to calculate the amounts paid by insurance and out-of-pocket on prescription drugs from 2004 to 2016. We use a sample of between 1.2 and 19.8 million enrollees per year to analyze the change from 2004 to 2016 in opioid-related spending and utilization.

Private insurance covers nearly 4 in 10 non-elderly adults with opioid addiction


Nearly 4 in 10 (37%) people dealing with an opioid addiction in the United States are covered by private insurance.

The share of people with large employer coverage taking opioid prescriptions is at its lowest levels in over a decade


The share of large employer enrollees with an opioid prescription reached its peak in 2009, when nearly 1 in 5 (17.3%) patients received a prescription for this drug class. It has since fallen to a recent low of 13.6% in 2016.

The number of large group enrollees with an opioid prescription has declined from 2009 to 2016


Similarly the number of patients with any opioid prescription during the year has fallen since peaking at 13.6 million people in 2009. It is currently at a 12 year low of 11.5 million people in 2016.

Among people with large employer coverage, older enrollees are more likely to have an opioid prescription


Among those with large employer coverage, older patients are more likely to receive an opioid prescription, while children (those ages 17 and under) are the least likely.

Among those with large employer coverage, most opioid prescriptions are in the south


When breaking down the geography of opioid prescriptions, the South and Midwest regions. have the highest level of opioid prescriptions among those with large employer coverage.

Opioid use declined across disease categories, particularly pregnancy, musculoskeletal diseases, and injuries


Among people with large employer coverage, this pattern (of increasing opioid prescription use through about 2009, followed by a drop-off through 2016) is similar across a wide variety of diagnoses. Some of the steepest declines in opioid prescription use since 2009 were among people with complications from pregnancy or childbirth, musculoskeletal conditions, and injuries.

Patients with musculoskeletal diseases are almost 4 times more likely to have opioid prescriptions than those without a diagnosis


Having a diagnosis of a musculoskeletal disease greatly increases the likelihood that a patient will have an opioid prescriptions. The percentage of people with a prescription without this condition has consistently been about 10% until a recent decline to 7%, while at least 30% of those with the condition have a prescription. However even those with such a diagnosis have seen a decrease in opioid prescriptions since 2009.

Among those with an opioid prescription the share of patients with only one opioid prescription has slightly increased over time


In the decade between 2006 and 2016 there was a slight shift in the distribution opioid prescriptions given per patient. As overall prescriptions have declined there has also been a increase in patient only receiving one opioid.

Spending on opioid prescriptions peaked in 2009


Spending on opioid prescriptions by large employer plans increased from 2004 to 2009 and then decreased from 2009 to 2016. The majority of the spending on these prescriptions is done by insurance and the proportion has remained relatively stable over time. 

The average spending on opioid prescriptions has increased slightly since 2004


The average spending on opioid prescriptions have remained relatively stable over time. The average spending for a prescription was $41 dollars in 2004 and rose to period high of $48 in 2015 before falling to $44 in 2016.

Spending on opioids varies from the highest in the South to the least in the Northeast


Spending on opioid prescriptions is most in the South and lowest in the Northeast.

On average, opioid prescriptions are more expensive in the Northeast than in other regions


The cost of an opioid prescription for enrollees of large employer plans varied across each region, from an average cost of over $61 in the Northeast to an average of $37 in the Midwest.

Among people with large employer coverage, people age 55-64 represent the largest share of opioid spending


The largest share of total spending on opioid prescriptions is on those age 55-64, followed by 45-54 and 35-44. Total out-of-pocket spending in about 1/5 of the total spending.

People in the their late teens and early twenties are most likely to report having an addiction to opioids


The highest rate of use of prescription opioids for nonmedical purposes are from people in their mid-twenties to mid-thirties. The lowest rates are among those 65 years or older.

The cost of opioid addiction and overdose treatment has risen, even as opioid prescription use has fallen


In response to the rising rates of opioid addiction and overdose, treatment spending has increased considerably since 2006. Total spending on inpatient care, outpatient services, and prescriptions to treat opioid addiction and overdose grew from less than $300 million to over 2.5 billion in 10 years. 

Spending on opioid addiction and overdose treatment has increased each year in the last decade


The spending on opioid addiction and overdose treatment increased since 2004 for both inpatient and outpatient settings. However, the fastest growth has been in outpatient spending, which rose over 1,400% in 12 years.

The annual cost of opioid addiction and overdose treatment prescriptions has grown by nearly 20x since 2004


The total spending on opioid addiction and overdose treatment prescriptions has increase significantly from 2004 to 2016. In 2004, less than $25 million was spent on drugs for opioid addiction and overdose treatment for patient in large employer plans, however that number had grown to over $400 million by 2016.

Spending on opioid addiction and overdose treatment is mostly concentrated among younger people


The areas of the largest concentration of spending for opioid addiction and overdose treatment for enrollees in large employer plans was on young adults ages 18-34 and men.

Children and other dependents account for the largest share of large employer spending opioid addiction and overdose treatment


Most of the spending on opioid addiction and overdose treatment is dependents of enrollees of larger employer plans. In 2016, total spending was $576 per 100,000 spouses and $214 per 100,000 children or other dependents. 

The portion of all spending going to opioid addiction and overdose is small but increasing over time


The share of total inpatient spending on opioid addiction and overdose treatment has consistently been larger than the treatment share of outpatient spending . However, both of these as well as overall treatment spending on medical services (not including retail prescriptions or durable medical devices) have increased in the last few years. 

Average spending for treating opioid addiction and overdose has increased dramatically since 2007


Spending on opioid addiction and overdose treatment for patients in large employer plans has increase steadily in the past several years. Average per person cost rose from under $4 in 2007 to nearly $26 in 2016.

Average inpatient spending on opioid addiction and overdose treatment has increased in the last decade


The amount that has been spent on care for inpatient opioid addiction and overdose treatment has intensified in the 8 years from 2008 to 2016. Among those with inpatient spending on opioid addiction and overdose, the per person per year spending more than doubled from $6,500 to over $16,000 during that time period. 

Average outpatient spending on opioid addiction and overdose treatment has increased in the last decade


Among large group enrollees with outpatient opioid addiction and overdose, the per person per year treatment cost for outpatient opioid addiction has risen significantly over the past 12 years. The growth in spending began a sharp increase starting in 2010 and continuing to 2016.