Prime Therapeutics has studied the costs and clinical events relationship among their members using a controlled substances (CS) score algorithm that identifies potential overuse/abuse of opioids/controlled substances, according to Prime’s Director of Health Outcomes Pat Gleason, PharmD, FCCP, BCPS.
“Our study findings, presented at the 2015 AMCP Annual meeting [in April], found a high-statistically significant-relation between increasing CS score and costs as well as clinical events.”
A one point change in controlled substances score was associated with an increase in $1,488 total healthcare costs, 0.9% increase in hospitalizations, and 1.5% increase emergency department visits.
Previous research demonstrated a prescriber letter intervention, using the CS score 12 or higher and 12 or more CS claims over 90 days as the intervention threshold, was able to reduce the CS score an additional 1.36 points compared to a control group. Findings from this study allow for the translation of the 1.36 point reduction in CS score for a 10,000 life group to potential cost avoidance of $40,480 annually or $0.34 per member per month.
“Health insurers should be actively identifying members who are either at risk for CS misuse/abuse or who appear to be over utilizing CS drugs and engage prescribers,” Gleason says