Puerto rico government

Prime Therapeutics’ Intervention Pilot for Opioid Users Improves Outcomes

Opioid registry and predictive modeling help identify at-risk Medicare members in Florida

EAGAN, Minn., July 18, 2022 /PRNewswire/ — During the COVID-19 pandemic, drug overdoses killed more than 107,000 Americans in 2021.1 Prior to the pandemic, Prime Therapeutics LLC (Prime), a leading Pharmacy Benefit Manager (PBM) serving nearly 33 million members nationwide, launched an intervention program targeting Medicare members with high risk of opioid overuse. A pilot project with Medicare members from GuideWell Mutual Holding Corporation (GuideWell), which is the parent company of a leading health plan in Floridasaw a decrease in opioid claims and a decrease in morphine milligram equivalent (MME) dose for members who received communications.

The program used Prime’s GuidedHealth Opioid Registry — a list that helps identify Medicare members who were either new to opioids or current opioid users and at risk for opioid-related harm. The registry also feeds into Prime’s predictive model which determines the likelihood of a member crossing the ≥50 and ≥90 MME thresholds daily over the next six months. Together, the registry and the predictive model help prevent opioid abuse for members.

New opioid beginners and current opioid users had custom pilot designs:

  • New Opioid Starters: This group received communication from members with messages about what an opioid is, how it works, and how to use and dispose of it safely. A control group from a health plan client of similar size was used.
  • Previous opioid users: This group received a communication from members and a corresponding communication from prescribers containing information on the safe use and disposal of opioids. The communication also encouraged the member to speak with a physician or pharmacist about naloxone, a drug that reverses an opioid overdose in an emergency. A control group from a health plan client of similar size was used.

“Prime has been working on managing opioid use and abuse for over a decade. Creating personalized approaches to help members based on where they are in their journey of opioids is essential to help improve their health,” said David Lassen, PharmD, Clinical Director at Prime. “Results from this pilot project show improved member behavior with opioids, particularly with opioid cessation, as well as insight into future efforts for all opioid users.”

Both pilot groups had positive results to report:

  • New Opioid Starters: Compared to the control group, opioid newbies had a 37% decrease in MME use and a 29% improvement in discontinuing opioids.
  • Previous opioid users: This group had a 7% decrease in opioid prescriptions, a 2.8% increase in naloxone prescriptions, and a total of 10% of members who stopped opioids during the follow-up period.

“We are committed to fighting the opioid epidemic among our members with a variety of methods and we appreciate Prime’s work as our Pharmacy Benefits Manager to help us lead this fight,” said Cynthia Griffin, PharmD, Vice President of Medicare Pharmacy Programs at GuideWell. “Using our Medicare member claims data, integrated with Prime data, to inform predictive modeling creates personalized programs for members. These personalized approaches provide opportunities to have positive impacts that improve outcomes members related to opioids. This has the potential to save lives during the ongoing fight against opioid misuse and abuse, and our members benefit from this work.”

Learn more about Prime’s controlled substance management program.

  1. Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). (May 11, 2022). (representing.). Overdose deaths in the United States in 2021 have increased by half compared to 2020 – but are still up 15%. Extract of https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm

About GuideWell

GuideWell Mutual Holding Corporation (GuideWell) is a not-for-profit mutual holding company and the parent company of a family of forward-thinking companies focused on healthcare transformation. The GuideWell organization includes Florida Bluefirst health insurance company in Florida; Triple-S Management, a leading healthcare services company in Porto Rico; GuideWell Health, a portfolio of clinical care delivery organizations; GuideWell Venture Group, a portfolio of companies including Onlife Health and PopHealthCare focused on creating innovative, human-centric health solutions for health plans; GuideWell Source, an administrative service provider for state and federal health care programs; and WebTPA, a market-leading administrator of self-funded employer health plans. In total, GuideWell and its affiliates serve more than 46 million people in 45 states, Porto Rico and the US Virgin Islands. For more information, visit guidewell.com.

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About Prime Therapeutics

Prime Therapeutics LLC (Prime) helps people get the medicines they need to feel better and live well. Prime provides comprehensive medication management solutions for health plans, employers, and government programs, including Medicare and Medicaid. The company handles claims and provides clinical services for people with complex health conditions. Prime serves over 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of these plans. For more information, visit www.primotherapeutics.com or follow @Prime_PBM on Twitter.

Guided Health®is one of Prime Therapeutics’ foundational clinical products to enable total medication management through improved care and outcomes, increased safety and ultimately lower total cost of care. It does this by helping members and prescribers make better decisions about medication management. Using integrated data and industry-leading analytics, our next-generation clinical engine and population health database – GH360 provides a holistic view of each member’s clinical events and opportunities.

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Denise Lecher
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SOURCE Prime Therapeutics LLC