Prime Therapeutics study shows drug utilization review letter to providers helps reduce high-risk controlled substance use Two new studies reveal methods to identify and reduce controlled substances and opioid abuse and misuse

ST. PAUL, Minn., Oct. 7, 2013 /PRNewswire/ -- The misuse and abuse of controlled prescription drugs, such as opioid pain medications, is a serious public health issue. Strategies to identify and intervene with high-risk users can help reduce potential abuse and misuse of the drugs, according to two new studies by pharmacy benefit manager Prime Therapeutics LLC (Prime). Prime is presenting the studies at the Academy of Managed Care Pharmacy (AMCP)'s Nexus 2013 conference in San Antonio on Oct. 17, 2013.

High-risk opioid users more likely to have back pain

In its first study, the Prime health outcomes team examined pharmacy claims data from one U.S. commercial health plan in 2012 to identify members at high risk for adverse events from opioid use. Among the plan's approximate 1.3 million continuously enrolled, commercially insured members, nearly one in four (23.9 percent, or 303,272 individuals), had at least one opioid claim, with a total paid of $32,208,618.

Using methods established by the Centers for Medicare & Medicaid Services (CMS), a daily morphine equivalent dose (MED) was then calculated to identify a subset of 2,786 individuals (1 in 455) who were at high risk for overdose or death because they were taking high doses of opioids (>120 MED) for 90 consecutive days.

The most common characteristic of the 2,786 identified as "high-risk" opioid users was that they had a back pain diagnosis (86.3% percent). By comparison, only 37.7% of those using opioids at <120 MED had a back pain diagnosis. The rate of cancer among high-risk opioid users was nearly the same as those with <120 MED. Other conditions more frequently found in high-risk opioid users were opioid dependence or abuse, muscle or limb pain, neck pain, and non-opioid dependence or abuse.

"A significant number of members are taking prescription pain killers and the ability to identify those at risk of overdose or death will help insurers and providers intervene more quickly," said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime. 

Study shows letter to prescribers can curb high-risk controlled substance use

Patients abusing or misusing these drugs may seek out prescriptions from more than one provider, making it difficult for providers to track unsafe use. Through Prime's GuidedHealth® Controlled Substance Drug Utilization Review (DUR) program, prescribers receive an individualized prescription profile for each patient, listing all pharmacy claims (including those written by other providers) for controlled medications filled over a three-month review period. Possible areas of concern are clearly highlighted for the prescriber.

To measure the impact of the DUR program, in the second study Prime conducted an analysis of more than 1.2 million members whose pharmacy claims were used to identify controlled substance claims. High-risk use was measured using a score based on the number of controlled substance claims (DEA Class II to IV substances), number of pharmacies and prescribers, and use patterns over three months. Reviewing prescriptions filled between November 2011 and February 2012, Prime identified 681 individuals whose claims suggested high- risk prescription utilization patterns during this time. A DUR letter was then mailed to the 1,833 prescribers of these members. A control group of 713,556 members who did not receive the intervention was also reviewed, and 346 high-risk members were identified in this group.

Controlled substance claims were then reviewed again six months after the intervention. Compared to the control group, when the DUR letters were mailed to prescribers, high-risk members were more likely to decrease their controlled substance use. In fact, use of the drugs dropped by one-third in the group receiving the intervention, compared to only 23 percent in the group that did not receive the intervention. The decrease in use also resulted in an estimated net $210,566 in controlled substance medication cost savings over a three-month period.

"Prescription drug abuse is a considerable concern," said Gleason. "Our study suggests an actionable letter to prescribers with member specific prescription claims information can help decrease potentially inappropriate prescription medication use among high-risk individuals."

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 23 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation. 

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


Sheila Thelemann

Prime Therapeutics

Director, Corporate Communication


SOURCE Prime Therapeutics


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