Prime Insights

America’s opioid epidemic: Part 5 — the future of safer opioid use

Cathy Starner, PharmD, BCPS | July 20, 2016


Positive outcomes for members. Sustainable costs for plan sponsors. Prime Therapeutics' opioid management goals are simple, and we’re achieving them. We know who’s using opioids, and who’s at the highest risk for abuse. Our clients are employing proven strategies for curbing abuse. And we’re actively lobbying for public policies that can continue to drive meaningful change. But it’s an ongoing effort.

There’s still important work to be done on the opioid front. As a pharmacy benefit manager, one of our greatest assets is knowledge. We have insight into opioid use among our 22 million members, and our unique connection with Blue Cross and Blue Shield Plans allows us to study how this use impacts medical care and costs. As we continue to dive deeper into the data to uncover patterns and correlations, we continue to offer insight that can help plan sponsors provide opioid programs to encourage safe use, improve outcomes and lower costs.

Advancing prevention and intervention through research
Much of our research focuses on finding ways to identify those at risk for opioid abuse sooner. Doing so means we can intervene more quickly, potentially preventing the complications and consequences of abuse or overdose. In addition to our current programs, we’re conducting new research and studies, including:

  • Enhanced predictive modeling
    We're working to identify controlled substance misuse predictors using our controlled substance score, test the prediction accuracy, and isolate factors that can be influenced through pharmacy benefit services.
  • GuidedHealth opioid alert program
    Our opioid alert program helps to find members whose claim history may indicate opioid misuse or abuse. The goal of the program is to find members before they're identified through the Centers for Medicare and Medicaid Services (CMS) overutilization monitoring system. Our opioid alert program has stricter opioid use criteria than the CMS system, offering potential for these members to be identified earlier.
  • Telephonic pharmacist interventions and case management
    GuidedHealth is already in place for many of our clients. We’ve also tested alerts at the pharmacy counter. In our newest program, a Prime pharmacist is personally calling doctors to discuss risk factors and potential treatment alternatives if their patient has been unresponsive to previous intervention attempts.
  • Short-acting, long-acting and abuse deterrent opioid utilization patterns study
    With new federal law expected to encourage the development of new abuse deterrent opioid products, plan sponsors will need to understand their population’s utilization patterns, as there may be significant impact on future drug spend. Look for more on this study this fall.
  • Controlled substance prescriber outliers
    Analyzing claims data can help shed light on prescribers who are writing a disproportionate number of prescriptions compared to their peers. This information can then be provided to plan sponsors to enact positive change.
  • Lock-in programs
    A small number of members with persistent opioid misuse and abuse may be referred for a pharmacy or prescriber lock-in. This means they are “locked in” to using one doctor or pharmacy for their opioid prescriptions. We’re continuing to explore the best way to identify these members, system requirements, and how we can engage health plan clients for their expertise.

As opioid management continues to evolve, Prime will continue to test and research solutions that can help our clients manage costs while helping members get the medicine they need to feel better and live well. To learn more about Prime’s opioid work and expertise, contact us.


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 just over 22 million people. It is collectively owned by 14 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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