Controlled substances

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.

Woman With Glasses Staring Intently at Large Computer Screen

CS Score

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

CS Score Showing Venn Diagram with Three Circles, One Saying

More about our thought leadership


July 31, 2019

Prime showcases its controlled substance work at national conference

Pat Gleason and Jo-Ellen Abou Nader discuss the value of artificial intelligence using Prime’s integrated medical and pharmacy data

Perspectives, Stories

April 21, 2020

Driving Medicaid dollars to do more

Dedicated Medicaid teams drive value programming for Prime clients


June 15, 2018

Reducing opioid use among outliers; are we doing enough?

Prime helps health plans address members whose opioid use puts them outside the norm


November 30, 2017

Study of short-acting, long-acting and abuse-deterrent opioid use

The mix of opioids is crucial to the cost impact of abuse-deterrent opioids