Prime Therapeutics study finds intervention can reduce use and cost of controlled substances among high risk users A pharmacist consultant program was associated with reduced drug abuse risk scores, claims and number of prescribers and pharmacies among high risk controlled substance users

ST. PAUL, Minn., March 31, 2014 /PRNewswire/ -- In 2010, nearly 15,000 people died from overdoses involving prescription painkillers—more than those who died from heroin and cocaine combined.1 Recognizing that prescription drug abuse is an epidemic, Prime Therapeutics LLC (Prime) began monitoring controlled substance users through its pharmacist consultant program. Prime found decreases in controlled substances (CS) scores, CS claims and unique prescribers and pharmacies per user over a 3-month period. Prime will be presenting its results at the Academy of Managed Care Pharmacy's 26th Annual Meeting & Expo in Tampa, Fla.

Prime reviewed Medicare Part D administrative pharmacy claims from more than 1 million members to identify those who potentially were overusing CS. Prime identified members based on an internally defined CS score and a daily morphine equivalent dose of more than 120 milligrams.

Prime attempted to contact the doctors of these members up to four times to determine if therapy was appropriate or if changes were necessary. If the doctor did not respond, therapy was considered inappropriate and changes were made. Of the 158 members who met the intervention criteria, Prime found about half (77) had doctor directed changes and one had no response. After implementing the CS therapy changes, Prime analyzed the CS claims for these 78 members.

The study found the average CS score declined 40 percent, CS claims decreased 33 percent (from 18 to 12) and opioid claims decreased 40 percent (from 12.9 to 7.8). The number of unique pharmacies decreased for both CS (down 29 percent from 3.1 to 2.2) and opioids (down 36 percent from 2.8 to 1.8), as did the number of unique prescribers. Over three months, there was a CS claims savings of $17,160 – an average of $220 per member.

"We found that a pharmacist consultant program was associated with reduced controlled substances use among high risk members," said Cathy Starner, PharmD, BCPS, senior health outcomes researcher for Prime. "Controlled substance abuse is an epidemic in this country, and this study demonstrates the value of clinical programs to help monitor and intervene upon high risk members."

1 Centers for Medicare and Medicaid Services. Prescription Painkiller Overdoses in the U.S. Available at:

About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized by Modern Healthcare as one of "healthcare's hottest companies for 2013." 

For more information, visit or follow @Prime_PBM on Twitter.

SOURCE Prime Therapeutics LLC


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