Prime Therapeutics study finds high risk opioid users have medical costs three times higher than other opioid users

April 1, 2014

Rate of high risk use low among commercially insured

ST. PAUL, Minn., April 1, 2014 /PRNewswire/ — People who are at high-risk for opioid abuse use had significantly higher total medical costs ($19,513 vs. $5,493) than those who were not at high risk according to a new study by Prime Therapeutics (Prime). The Centers for Medicare & Medicare Services (CMS) defines high risk as “using a daily morphine equivalent dose (MED) of greater than 120 mg for at least 90 consecutive days, plus using more than three pharmacies and more than three unique prescribers.” Prime, a leading pharmacy benefit manager, will be presenting these findings at the Academy of Managed Care Pharmacy’s 26th Annual Meeting & Expo in Tampa, Fla.

During the first half of 2013, Prime reviewed opioid claims from more than 9 million commercially insured members. The research found nearly 1.2 million (13.1 percent) had at least one opioid claim. While 11,518 (0.13 percent) met the MED threshold, just 225 (0.0025 percent) met all three CMS high risk criteria. The number of commercially insured members considered high risk for prescription opioid abuse was five times lower than the rate among Medicare Part D members.

Those meeting all three criteria did not have significantly different pharmacy costs. Prime’s study excluded members being treated for cancer as CMS does in its analysis.

The average age for members meeting all criteria was 43. Back, neck and abdominal pain, and arthritis were among the most common pain diagnoses in this group. Anxiety, bipolar disorder and depression were more common than in the group that just met the MED criteria.

“Nationally, as many as 2 million people a year use opioids for non-medical purposes, and identifying high risk indicators can help prevent abuse and misuse of these medications,” said Pat Gleason, PharmD, BCPS, FCCP, director of health outcomes for Prime.

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 25 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized by Modern Healthcare as one of “healthcare’s hottest companies for 2013.”

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

SOURCE Prime Therapeutics LLC

Source: PR Newswire

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