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Radar On Market Access: Prime PBM's Studies Show Promise for Managing Opioids

Posted by Judy Packer Tursman on Nov 20, 2018

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Researchers from Prime Therapeutics LLC recently presented studies on two approaches to managing the use of opioid medications, AIS Health reported.

In the first opioid study, Florida Blue, Prime and Walgreens piloted a program where pharmacists gave a one-page opioid safety guide to Florida Blue members whose claim histories showed high opioid and controlled substance use when they picked up opioid prescriptions from a Walgreens pharmacy. The guide explained safe use, safe storage, safe disposal and overdose prevention for opioids, and included information on naloxone, a treatment used to counter the effects of an opioid overdose.

The intervention group, of 753 Florida Blue commercially insured members with pharmacy benefits through Prime, was compared with a similar group who used a non-Walgreens pharmacy and did not get the safety guide. With the intervention, researchers found "a statistically significant four-fold increase in the likelihood of a member receiving naloxone the next time they picked up an opioid prescription."

Prime says the collaboration between the plan, PBM and pharmacy shows it is possible to identify high-risk opioid utilizers and increase the dispensing of naloxone — in keeping with the FDA's efforts to increase the antidote's availability as a means to reduce opioid overdose deaths — through a targeted process.

"Prime is currently working with Walgreens to operationalize an expansion of this [safety guide] program," says Patrick Gleason, Pharm.D., Prime's senior director of health outcomes. "A broader rollout is expected in 2019."

In the second study, Prime's researchers set out to develop a high-dose opioid predictive modeling process for Medicare members to identify them early, before they become high-risk opioid users.

Prime says it determined that separate predictive models are needed for first-time opioid users vs. those already using the drugs, and this approach resulted in "highly accurate" predictive models scoring and ranking the Medicare members on their future likelihood of getting high-dose opioids.

"We will be incorporating opioid predictive modeling scoring and ranking into our Medicare clinical programs beginning in first quarter of 2019," Gleason says.


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Topics: Industry Trends, Payer, Specialty, Provider, Data & Analytics