Prime Therapeutics Sees Drop in Opioid Claims


A 13% decline in the past year continues downward. Some of the decline might be explained by pandemic-related drop in healthcare utilization.

The opioid epidemic is hardly over, but Prime Therapeutics, the PBM for 23 Blues plans, is seeing notable declines in a number of measures of opioid prescribing among its claims.

In a review of it claims data from 16 million commercial members over the past year, Prime found a 13% decline in the number of members with an opioid claim and a similar reduction (12%) in members with a prescription for a high dose of opioids (90 morphine milligram equivalents or above).

Catherine Starner

Cathy Starner

“Obviously it is a good thing, we think, if there are fewer people getting opioids prescribed to them, because there are just a few instances when you actually need an opioid for pain control,” Cathy Starner, Pharm.D., health outcomes consultant senior principal, said in a recent interview with MHE.

Starner said the decline in opioid prescriptions be partly because of the pandemic-related decline in healthcare utilization, which was particularly steep during April and May of last year. But she also noted that the decline in opioid prescriptions among Prime’s claim goes back several years, so the recent decline is part of longer-term trend.

Prime has also seen a decline in its claims in the average days’ supply of opioids, from 16 to 15 days.

“Instead of you getting the seven-day supply day, when you are getting 50 tablets or whatever might be, you are getting 20 tablets for a three-day supply,” said Starner.

Prime, which is headquartered in Eagan, Minnesota, a Twin Cities suburb, has several programs designed to curb excessive and potentially harmful opioid prescribing, including utilization management at the point of sale. “If you are getting aprescription for the first tine and you don’t have any claims in your history, you probably don’t need a high dose or a large supply of an opioid,” Starner said.

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