Prime salutes its unsung heroes during National Pharmacists Month

Prime Therapeutics’ clinical review team is on the front line in fighting controlled substance abuse

October 28, 2019
Prime’s award-winning controlled substance management program is saving lives and money, thanks to hundreds of pharmacists and pharmacy technicians on Prime’s clinical review (CR) teams. That’s why during National Pharmacist’s Month, it’s important to take a moment to highlight the important work they do which often goes unnoticed.

“The cool thing about my job, is that I have direct influence on preventing opioid abuse, on a daily basis, when evaluating the appropriateness of opioid therapy,” says Ibrahim, a pharmacist on the CR team. “By reviewing cases for appropriate use, I do my small part to push back against this epidemic that’s negatively affecting so many members and push toward a better future.”

Ramping up the fight

Prime launched its first controlled substance management program more than a decade ago — years before the opioid crisis made headlines. Since then, many improvements have been made to better predict potential opioid abuse and protect patients from harm, including a new drug utilization review (DUR) process introduced last year.

To provide timely answers to members regarding their drug approval requests, Prime streamlined opioid DURs by removing multiple forms and consolidating into one opioid-specific form for providers to use. “Having all information up front helps avoid multiple reviews, which could delay the patient in getting the medicine they need,” says Sadiq, a clinical operations pharmacist manager.

“I’m proud of the clinical review teams’ dedication to helping our members use these drugs safely and appropriately,” says Dustin Cheek, vice president of clinical and contact center operations.

Taking a closer look

The following DUR program elements are critical to protecting members:

  • Performing holistic reviews to ensure members are not taking opioids in combination with drugs that may be dangerous, and contacting prescribers if necessary.
  • Reviewing new-to-therapy prescriptions for medical justification when prescription amount exceeds a seven-day supply.
  • Reviewing prescriptions that exceed per-day dose limits and gathering additional information to support the increased dosage.
  • Encouraging prescribers to check state databases for controlled substance refills to prevent people from using multiple prescribers and/or pharmacies to obtain dangerous amounts of opioids.

“With the new DUR process, I feel I’m able to help fight the opioid crisis by having important clinical discussions with prescribers about the proper use of these medications,” says Katrina, a pharmacist on the CR team.

Similarly, Paul, a senior director in clinical operations, highlighted a recent pilot program in which Prime pharmacists called providers for all opioid requests. “This direct clinical conversation helps ensure providers have a plan for managing the member’s pain, are using opioids safely and provide appropriate documentation,” he says. “We’re really making a positive difference in people’s lives.”

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