March 27, 2017
Two Prime Therapeutics studies highlight strategies for addressing opioid epidemic
Managed care pharmacist consultations and review of concurrent opioid and benzodiazepine use: working to address safety and reduce costs.
ST. PAUL, Minn. – Two studies to be presented by pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) at the Academy of Managed Care Pharmacy’s (AMCP) 2017 Annual Meeting next week highlight strategies to address safe opioid use and the nation’s growing opioid epidemic.
The first study analyzed concurrent use of opioids with benzodiazepines and was recognized with a silver award from AMCP. Previous research has shown concurrent use of these two types of drugs can increase the risk of overdose and death. Prime’s study found more than one in six opioid users without cancer – or nine per 1,000 commercially insured members – used these two drugs concurrently for 30 days or more in 2015.
The study reviewed integrated pharmacy and medical claims of 15 million commercial members from 2015 and found nearly 3.7 million members age 18 or older had at least one opioid or benzodiazepine claim during the year. Of those, 884,407 had two or more opioid claims, and 234,996 of those members also had two or more benzodiazepine claims. After excluding members with a cancer diagnosis, 132,308 (17 percent) of 777,035 opioid users had concurrent opioid and benzodiazepine use for 30 days or more in 2015.
“We found nine per 1,000 (0.9 percent) of Prime’s entire commercially insured population were currently using an opioid and benzodiazepine. This means an alarming number of individuals are using the combination, placing themselves at increased risk,” said Cathy Starner, PharmD, principal health outcomes researcher at Prime. “The Pharmacy Quality Alliance (PQA), a nonprofit organization representing stakeholders interested in improving the quality of the medication-use system, recently endorsed the ‘Concurrent Use of Opioids and Benzodiazepines’ pharmacy quality metric. Health plans need to put steps in place to identify these members early and intervene, to ensure they are taking these medications safely.”
A second study – recognized as a gold award winner by AMCP – found pharmacists based in a PBM or health plan, who do outreach to prescribers, can reduce emergency room visits and controlled substance drug costs among persistent users of controlled substances. For the study, Prime researchers identified an intervention group of 213 members taking controlled substances from among one million commercially insured health plan members. A letter followed by telephone outreach was made to prescribers to discuss controlled substance regimens and suggest changes that could potentially improve member safety. A concurrent control group of 1,387 members, that received no prescriber outreach, was also identified from among 3.3 million commercially insured members.
Following the outreach, controlled substances drug costs per member for the intervention group dropped from $5,802 to $5,148, while controlled substance drug costs increased for the control group from $3,511 to $3,627 per member. Emergency department visits were 6.4 percent lower in the intervention group, compared with the control group.
“Over a one-year period, managed care pharmacist to prescriber outreach led to fewer emergency room visits and lower controlled substance drug costs among members using controlled substances,” said Starner. “Opioid abuse and misuse has become a leading cause of death in this country, claiming thousands of lives each year. It’s critical that controlled substances are used appropriately for members who need them and this study shows managed care pharmacists can play an important role.”
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. Prime serves nearly 20 million people. It is collectively owned by 14 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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Manager, Corporate Communications