Prime Therapeutics study links controlled substances score to health outcomes, cost of care
Analysis identifies opportunities to help reduce controlled substance abuse and lower costs
ST. PAUL, MINN. – Feb. 16, 2015 – In the past decade, drug overdose deaths have more than doubled and over 50 percent were related to prescription drugs.1
To help curb this growing epidemic, Prime Therapeutics LLC (Prime) uses a controlled substance (CS) score that identifies high risk CS drug use. Through analysis of the CS score, Prime found a significant association between CS scores and health outcomes (hospitalizations and emergency room visits), CS drug costs, and total cost of care.
“Controlled substance abuse is an ongoing problem in this country,” said Cathy Starner, PharmD, BCPS, principal health outcomes researcher for Prime. “We developed our CS score to help health plans identify and intervene with high risk members. Validating the CS score association with health care use and costs helps quantify the potential value of an intervention.”
The CS score is determined using three months of a member’s CS claims. The score includes the number of CS claims, number of health care professionals who prescribed the CS drugs, number of pharmacies that filled the CS prescriptions, and the rate of CS drug use. For this study, Prime reviewed claims from 11 million commercially insured members. Prime then analyzed a group of nearly 1 million of those members who were continuously enrolled in all of 2012 and 2013 with a CS score of 2.5 or higher (range 2.5 to 21). In terms of health care use and cost, Prime found that a one point increase in CS score is associated with:
- $1,488 higher total cost of care
- $235 higher controlled substance drug cost
- 0.9% increase in hospitalization rate
- 1.5% increase in emergency room visit rate
Helping doctors spot and stop abuse is an effective way to lower CS scores. Prime’s previous research demonstrated a 1.4 point reduction in members’ CS scores associated with a prescriber letter intervention.2
Compared to a concurrent control group, this change was statistically significant. This new research suggests that such a letter program could help a 10,000 life insured population potentially avoid $40,800, or about 34 cents per member per month (based on a 0.2 percent member identification rate).
Full results of the study will be presented at the Alliance to Prevent the Abuse of Medicines/U.S. Chamber of Commerce Prescription Drug Abuse Event, Feb. 23 in Washington, D.C. and at Pharmacy Benefit Management Institute’s (PBMI) 2015 conference, March 2-4 in San Antonio.
1. CDC Home & Recreational Safety. Prescription Drug Overdose in the United States: Fact Sheet.
http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html Accessed Feb 3, 2015.
2. Daubresse M, Gleason PP, Peng Y, Shah ND, Ritter ST, Alexander CG. Impact of a Drug Utilization Review Program on High-Risk
Use of Prescription Controlled Substances. Pharmacoepidemiology and Drug Safety 2014;23(4):419-27.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 26 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.
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