Press release

Oct. 16, 2017

Prime Therapeutics controlled substance management program helped decrease opioid use among those at highest risk

Overall opioid use also decreased over the past 5 years.

ST. PAUL, MINN. – Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM) serving more than 20 million members nationally, examined opioid use and prevalence of high-risk outliers, and found a 71 percent decline in high-risk opioid users (outliers) in Prime’s commercial book of business over the past five years. Prime’s Controlled Substance Management Program, in concert with its health plan clients’ efforts, contributed to this result. The Silver ribbon winning research analysis will be presented at the Academy of Managed Care Pharmacy’s (AMCP) Nexus 2017 conference Oct. 16 to 19.

High-risk outliers, according to the Centers for Medicare & Medicaid Services (CMS) Opioid Overutilization Criteria for 2018, are members without cancer who have an average daily morphine milligram equivalent (MME) of 90mg or higher, and receive opioids from more than three prescribers and more than three pharmacies or from more than five prescribers regardless of number of pharmacies over a six-month period. In the first half of 2012, 1,255 members (12 per 100,000) were identified as outliers. In the first half of 2017, outliers were reduced to 494 members (3 per 100,000).

Additionally, Prime found a 16 percent reduction in tablet and capsule opioid claims per capita from January 2012 through June 2017. Other opioid utilization metrics that decreased over the past five years include the percent of members with an opioid claim (decreased 8.1 percent) and quantity dispensed divided by days supply (decreased 9.1 percent).

“Prime is seeing very positive outcomes from our data and analysis of opioid claims, however, focus cannot wane and we will be doing more to help the days supply (i.e., quantity per claim) decrease in accordance with the Center for Disease Control and Prevention’s guidelines,” said Cathy Starner, PharmD, principal health outcomes researcher at Prime. “We need to continue improving. For example, we will encourage adoption of days supply quantity limit for new opioid prescriptions and continue developing and improving our clinical programs that address opioid misuse and abuse. All stakeholders need to keep the momentum strong so we can build upon the progress we’ve made.”

Prime’s Controlled Substance Management Program is a comprehensive approach – inclusive of interventions aimed at prescribers, pharmacists and members – to help combat the current opioid epidemic. To identify potential opioid misuse before it starts, Prime plans to introduce a new predictive modeling tool in 2018, building on their current controlled substance scoring tool.

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 offers clinical services for people with complex medical conditions. Prime serves more than 20 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

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Denise Lecher
Manager, Corporate Communications