Prime has been a leader on controlled substances misuse for more than a decade. Our program combines existing and new services to help address this national epidemic.
New model reduces risk
Opioid misuse and over-prescription continues to be a major issue in the U.S. Our experience taught us that a multi-pronged model is the most effective way to fight this epidemic.
In addition to our current controlled substance efforts, we created a controlled substance management program. One of the highlights is a controlled substance score. It identifies people at risk of controlled substance misuse through predictive modeling.
The score is calculated by evaluating the:
- Number of unique controlled substance claims
- Total unique pharmacies and prescribers
- Utilization rate over time
This score then is used with our GuidedHealth® rules engine, which identifies drug therapy opportunities and encourages doctors to target and prioritize interventions.
Our history of managing the controlled substance crisis has contributed to a 71 percent decline of high-risk opioid users and a 16 percent decrease in opioid claims over the past five years for Prime’s commercial book of business, comparing the first half of 2012 to the first half of 2017.
Joining forces to fight controlled substance misuse
We’re doing our part, but everyone in the health care system has a role to play in this battle. Legislators, plan sponsors, pharmacy benefit managers, pharmacies and health care professionals all need to get involved.