Prime Therapeutics’ intervention pilot for opioid users improves outcomes

Opioid registry, predictive modeling help identify at-risk Medicare members in Florida

July 18, 2022

EAGAN, Minn. – During the COVID-19 pandemic, drug overdoses killed over 107,000 Americans in 2021.1 Prior to the pandemic, Prime Therapeutics LLC (Prime), a leading pharmacy benefit manager (PBM) serving nearly 33 million members nationally, began an intervention program targeting Medicare members who were at high risk of overutilizing opioids. A pilot with Medicare members of GuideWell Mutual Holding Corporation (GuideWell), which is the parent company to a leading health plan in Florida, saw decreased opioid claims and lower morphine milligram equivalent (MME) dosing for members who received communications.

The program used Prime’s GuidedHealth opioid registry – a listing that helps identify Medicare members who were either new opioid starters or current opioid utilizers and at risk for opioid risk harm. The registry also feeds Prime’s predictive model that determines a members’ probability of exceeding thresholds of ≥50 and ≥90 MME daily in the next six months. Together, the registry and predictive model help prevent opioid misuse for members.

New opioid starters and current opioid utilizers had customized pilot designs:

  • New opioid starters: This group received a member communication with messaging about what an opioid is, how it works and how to safely use and dispose of them. A control group of a similar sized health plan client was used.
  • Prior opioid utilizers: This group received a member communication and corresponding prescriber communication with information about safe use and disposal of opioids. The communication also encouraged the member to speak with a doctor or pharmacist about naloxone, a medicine that reverses an opioid overdose in an emergency. A control group of a similar sized health plan client was used.

“Prime has been working on managing opioid use and abuse for well over a decade. Creating tailored approaches for how to assist members based on where they are in their opioid journey is vital to helping improve their health,” said David Lassen, PharmD, chief clinical officer at Prime. “The results of this pilot show improvement around member behavior with opioids, particularly with the discontinuation of opioids, as well as insight for future efforts for all opioid users.”

Both pilot groups had positive outcomes to report:

  • New opioid starters: Compared to the control group, new opioid starters had a 37%-point decrease in MME use and had a 29%-point improvement in opioid discontinuation.
  • Prior opioid utilizers: This group had a 7% decrease in opioid prescriptions, a 2.8%-point increase in naloxone prescriptions and an overall 10% of members who discontinued opioids in the follow-up period.

“We are committed to addressing the opioid epidemic amongst our members with a variety of methods and we value the work of Prime as our pharmacy benefit manager to help us take on this fight,” said Cynthia Griffin, PharmD, vice president, Medicare pharmacy programs at GuideWell. “Using claims data for our Medicare members, integrated with Prime’s data, to inform predictive modeling, creates customized programs for members. These tailored approaches result in opportunities to have positive impacts that improve member outcomes related to opioids. This has the potential to save lives during the ongoing fight against opioid misuse and abuse, and our members benefit from this work.”

Learn more about Prime’s controlled substance management program.

  1. Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). (May 11, 2022). (rep.). U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 – But Are Still Up 15%. Retrieved from

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