Out-of-Pocket Payments for Outpatient Prescription Opioids

Prescription drugs are essential to improving the quality of life for millions of Americans living with acute or chronic pain. However, misuse, abuse, addiction, and overdose of these products, especially opioids, have become serious public health problems in the United States.

Total Expenses, Total Utilization, Distribution by Source of Payment and Average Total and Out-of-Pocket Payments for Outpatient Prescription Opioids in the U.S. Adult Civilian Noninstitutionalized Population, a statistical brief from the Household Component of the Medical Expenditure Panel Survey, presents estimates of total expenses and total purchases for outpatient prescription opioids for the U.S. civilian noninstitutionalized adult population in 2015.

The brief examines total expenses and total purchases, as well as the distribution of expenditures by source of payment and average total and out-of-pocket payments for all opioids. It also ranks the top four opioid products by total expenses in 2015, which are hydrocodone, oxycodone, tramadol, and codeine.

Only prescriptions purchased or obtained in an outpatient setting are included in these estimates. Prescription medicines administered in an inpatient setting or in a clinic or physician's office are excluded.

Highlights

  • In 2015, total outpatient prescription opioid expenses for adults totaled $10.7 billion with hydrocodone and oxycodone accounting for nearly three-quarters of total expenses ($5.0 and $2.8 billion, respectively).
  • Total outpatient prescription opioid purchases for adults totaled 152.8 million prescriptions with hydrocodone, oxycodone, and ramadol accounting for about 80 percent of these prescriptions (61.7, 33.0, and 26.5 million prescriptions, respectively) in 2015.
  • For adults during 2015, Medicare paid 33.2 percent of total expenses on outpatient prescription opioids, private insurance (including TRICARE) paid 29.6 percent, individuals and family members paid 19.3 percent, Medicaid/CHIP paid 11.0 percent, and other sources paid 6.9 percent.
  • The average annual total and out-of-pocket expense for outpatient prescription opioids per person among adults with one or more prescription drugs purchases in 2015 were $3,391 and $404, respectively.

Select to access Total Expenses, Total Utilization, Distribution by Source of Payment and Average Total and Out-of-Pocket Payments for Outpatient Prescription Opioids in the U.S. Adult Civilian Noninstitutionalized Population.

Page last reviewed November 2017
Page originally created November 2017
Internet Citation: Out-of-Pocket Payments for Outpatient Prescription Opioids. Content last reviewed November 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/out-of-pocket-payments-opioids.html