Budget impact of suzetrigine for the treatment of moderate-to-severe acute pain in Medicaid-insured adults

Opioids are commonly used to treat moderate-to-severe acute pain in the United States (US) but are associated with serious and costly outcomes including opioid use disorder (OUD). Suzetrigine is the first oral nonopioid treatment approved in the US in over 20 years for the treatment of moderate-to-severe acute pain in adults. The objective of this analysis was to estimate the budget impact of adding suzetrigine to a state Medicaid formulary.
A budget impact model (BIM) compared scenarios before and after suzetrigine was available from the perspective of a hypothetical Medicaid plan with 1 million (M) members. The population consisted of adults with moderate-to-severe acute pain managed with prescription medication. Inputs included drug costs and medical costs of treating nausea/vomiting adverse events (AEs) and OUD/opioid abuse. The budget impact of suzetrigine was calculated as the difference in total costs and costs per member per month (PMPM) between the scenarios.
Assuming between 3 and 10 thousand (k) adults with moderate-to-severe acute pain are treated with suzetrigine in place of prescription opioids in the first two years on formulary, suzetrigine was estimated to increase drug costs by $827k to $2.5 M, which was offset by $3.6 M to $10.8 M in savings from avoided nausea/vomiting AEs and OUD/opioid abuse. The addition of suzetrigine to formulary was estimated to result in a budget impact of −$2.8 M to −$8.3 M over two years, or −$0.11 to −$0.34 PMPM, translating to cost savings of $827 per patient treated with suzetrigine rather than an opioid over two years.
While suzetrigine was estimated to increase drug costs, the associated avoidance of common opioid AEs and OUD/opioid abuse was estimated to result in cost savings for a state Medicaid plan in the first two years on formulary.
Approximately half of patients with acute pain in the United States (US) receive prescription opioids. Though effective in managing pain, opioids pose tolerability concerns and carry risks of misuse and addiction, which can lead to higher risk of death, negative impact on quality of life, and higher healthcare costs. Suzetrigine is a new oral nonopioid medication approved in the US to treat moderate-to-severe acute pain in adults. This study calculated the financial impact to a hypothetical Medicaid plan’s budget of making suzetrigine available to patients. The calculations included the costs of acute pain medications and the costs of treating health problems associated with those medications, including opioid use disorder (OUD), opioid abuse, and nausea/vomiting. The number of patients expected to use suzetrigine following approval is unknown, so the analysis considered a range of potential utilization over a two-year time period. The budget impact was calculated as the difference in costs before and after suzetrigine was available under a Medicaid plan. The study found that depending on the number of patients using suzetrigine, having suzetrigine available would lead to a budget impact of −$0.11 to −$0.34 per member each month over two years, equal to a cost savings of $827 per patient treated with suzetrigine rather than an opioid in a Medicaid plan. Use of suzetrigine led to a reduction in the number of patients using opioids and a corresponding decrease in the number of patients who experience OUD/opioid abuse or nausea/vomiting. The increased drug costs from using suzetrigine compared to prescription opioids were offset by the cost savings from avoiding these negative health problems.