Out-of-Pocket Prices of Opioid Analgesics in the United States, 1999-2004

Objective. To determine the out-of-pocket prices of common opioid analgesics by medication, drug coverage, region, and year. Design. Retrospective cohort study using 1999-2004 data from the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. Setting. U.S. civilian noninstitutionalized population. Patients. Adults not enrolled in Medicaid who filled prescriptions for opioid analgesics between 1999 and 2004. Outcome Measures. Prices of prescribed analgesics were collected from receipts, medication containers, patient recall, and administrative records (N = 20,926 and 31,500, respectively). Results. Average out-of-pocket price of an opioid analgesic prescription was around $10, but the estimate is potentially misleading: A typical adult patient without drug coverage paid $12.86-$61.60 to fill his or her analgesic prescription, depending on medication. The extended-release formulations cost more than double the immediate release prices. For the analgesics studied, drug coverage lowered out-of-pocket prices by 50-85%, while market prices increased at a rate of 5.7-9% per year with little regional variation. Data did not include prices for medications not prescribed or prescribed, but not acquired. Conclusions. Independent of the diagnosis, patients' out-of-pocket price for prescribed analgesics fluctuated freely in the United States across time, region, and coverage status. These fluctuations potentially distort the delivery of effective pain management and further burden an already afflicted population.