ThoughtLdrshipContSubs

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.

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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.

More about our controlled substance score

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It's working

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.

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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.

We're working together for stronger advocacy

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More about our thought leadership