Point-of-sale intervention targets high-risk members

Everyone in the health care chain has its role

Local pharmacists provide health education within the community. A lot of people don’t know this, but local drugstore pharmacists are trained to do patient education. When you pick up a new prescription at the pharmacy, the pharmacist will usually ask if you have any questions. The pharmacist may even pull you aside to give you the prescription and go over dosing information, how to know if the medication is working, potential side effects, and interactions with other drugs or foods. 

Health plans work with hospitals and providers to provide the best possible care for patients. As part of their mission, health plans build relationships within communities to foster health. Blue Cross Plans across the country develop innovative programs to address the opioid epidemic within their communities. 

PBMs administer programs that help control opioid misuse and abuse. Utilization management (UM) programs like quantity limits, prior authorization and safety programs help detect potential misuse and support appropriate use guidelines. 

We had a plan where each of us— pharmacy, health plan and PBM worked together— to do even more

Opioid abusers frequently use other controlled substances (CS) at the same time, increasing their risk of overdose and death. Prime developed a controlled substance (CS) scoring system, calculated based on a count of CS claims, unique pharmacies, unique prescribers and increasing monthly CS utilization.¹

Our research showed that an increase in a member’s CS score was associated with an increase in a member’s health care costs and health care utilization.¹

We knew that members with opioid prescriptions weren’t getting enough information about addiction

In a recent public survey of people who had been prescribed opioids, only one in four respondents said they discussed the potential for addiction with a medical professional. Even fewer discussed safety – such as what to do in case of emergency (11 percent).² 

This is where Walgreens and their pharmacists came in. Pharmacists, along with doctors and nurses, are considered among the most trusted professionals to U.S. consumers.³ They are a respected source of information. This program tapped the pharmacist’s role as a health care provider. 

We knew that these members needed information about safety: safe use, safe storage, safe disposal and overdose prevention – including information on naloxone. 

Opioid users with certain risk factors (e.g., history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use) are at higher risk of overdose. The U.S. Surgeon General encourages high-risk opioid utilizers to have naloxone available because of this risk.⁴

The intervention targeted members picking up opioid prescriptions who had a high CS score and at least one opioid prescription. When these members went to their Walgreens pharmacy to pick up their prescription, it was flagged so that their Walgreens pharmacist gave them a special Opioid Safety Guide.

This wasn’t a stack of flyers you see in the front of the store. This was targeted. This was point of service for members with a high CS score, getting a prescription for an opioid. It required engagement on the part of the pharmacist and the member. 

The Opioid Safety Guide included the information these high-risk members needed – including information on naloxone. And based on the data, it had an impact. 

Of those who received the Safety Guide, four times as many followed up to fill a naloxone prescription when compared to the control group that did not receive the Safety Guide.

Members filling scripts for Naloxone

About the study

Included in the analysis were 1,400 commercially insured members with pharmacy benefits through Prime whose claim history showed increased opioid and other controlled substance use. These members filled most of their prescriptions at Walgreens retail pharmacies. We conducted the intervention over a three-month window in 2017. A control group had similar characteristics, but filled their prescriptions at non-Walgreens retail pharmacies.⁵

This wouldn’t have worked without all three organizations: the health plan, Prime and Walgreens

Prime worked with medical and pharmacy claims from the health plan to identify members at risk—members with high controlled substances utilization. And Walgreens signed on to deliver the point-of-sale education and make naloxone available. 

Prime has access to integrated medical and pharmacy claims because of its unique relationship with its Blue Plan owners. By mining medical and pharmacy claims data, Prime improves benefit design and clinical programs – and improves health outcomes and member safety. 

The Opioid Safety Guide is an example of the kind of innovative joint program Prime envisioned. It improves the member experience and puts an important overdose prevention product in hands where it is most likely to be needed. 

References

1. Starner C, Qiu Y, Gleason PP. A Controlled Substance Score: Is It Related to Health Care Utilization and Total Cost of Care? Academy of Managed Care Pharmacy: San Diego, CA, Apr 2015. Published: J Manag Care Pharm 2015;21(4a):S33.
2. KRC Research conducted this research via an online survey of 1,014 Americans age 18 and older, from August 28-30, 2017. The sample was drawn randomly from a large national consumer panel. Data has been weighted to reflect the demographic composition of the United States per the latest U.S. Census.
3. America’s most and least trusted professions, by Niall McCarthy. Jan. 11, 2019. Forbes. ©Forbes Media LLC. Accessed at: https://www.forbes.com/sites/niallmccarthy/2019/01/11/americas-most-least-trusted-professions-infographic/#454876657e94
4. U.S. Department of Health & Human Services. Surgeon General’s Advisory on Naloxone and Opioid Overdose.Accessed at: https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html. January 2018.
5. Champaloux S, Taitel M, Gleason PP, McClelland S. Impact of Distributing an Opioid Safety Guide at Prescription Pick Up. J Manag Care Spec Pharm 2018;24(10-a Suppl):S90.