Prime Therapeutics Study Finds Many People May Take Opioids Inappropriately

ST. PAUL, Minn, April 6, 2015 /PRNewswire/ -- Even though medical guidelines recommend against prolonged opioid use for conditions such as low back pain, headaches and fibromyalgia, many people may be taking long-acting opioid pain killers for these conditions, putting their safety at risk and incurring significant costs.  This is the main finding of a new study by pharmacy benefit manager Prime Therapeutics LLC (Prime). The study will be presented at the Academy of Managed Care Pharmacy (AMCP) 27^th Annual Meeting and Expo in San Diego, April 7-10, 2015. Clinical programs to help ensure people receive appropriate pain treatment could improve safety while saving costs, according to the study.

Opioid abuse is a problem in the United States. In addition to the addictive qualities of opioids, accidental injury due to cognitive impairment or overdose, can lead to hospitalization or death. In fact half of all drug overdose deaths are due to prescription medications, with the majority being opioids. To help improve safety, insurers often limit quantities dispensed and days supplied. They may also limit long-acting opioids to those with an appropriate diagnosis such as cancer. Guidelines from the American Society of Interventional Pain Physicians and a 2014 position paper by the American Academy of Neurology (AAN) discourage prolonged use of opioids in non-cancer patients, as well as the use of long-acting opioids – except in specific circumstances, such as severe pain that does not respond to short-acting opioids.

In an analysis of 12 million commercially insured members, Prime found that between July 2013 and September 2014, 8.8 percent of members had at least one opioid claim. Of these members, 93.7 percent received only short-acting opioids during the period, which is the preferred, first-line treatment. Only 1.0 percent received only long-acting opioids and 5.3 percent received both long and short-acting opioids.

Among those with an opioid claim, low back pain was the most common diagnosis among all opioid users. Specifically, 22.2 percent of those receiving long-acting opioids had been diagnosed with low back pain, 4.9 percent with headache and 2.3 percent with fibromyalgia. On average, the cost for those taking short-acting opioids was $72 per member, compared to $907 per member taking only long-acting opioids.

The analysis suggests a clinical program which assesses the appropriateness of long-acting opioids could help improve safety and reduce costs. Additionally, a program that identifies members with a significant number of claims in a short period, or those with diagnosed conditions that may not benefit from prolonged opioid use, could also prove beneficial.

"Our analysis found low back pain was the most common diagnosis among all members taking an opioid, even though medical guidelines suggest the risks are likely greater than the benefits for these individuals," said Catherine Starner, PharmD, BCPS, principal health outcomes researcher for Prime. "Inappropriate, prolonged opioid use could result in safety risks, as well as add costs for members and their health plan. Identifying these members and helping them find the most appropriate pain treatment for their condition could help reduce safety concerns."

Prime has several clinical programs aimed at preventing the misuse of prescription drugs. Lightly managed programs such as drug utilization review or more aggressively managed programs such as case management and prior authorization for certain opioids, can all be leveraged. It is important for each insurer to understand their own opioid utilization patterns so that the right members are targeted and successful clinical programs are developed.

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 more than 26 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 www.primetherapeutics.com  or follow @Prime_PBM on Twitter. 

SOURCE Prime Therapeutics LLC

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