Pharmacy Benefit Manager Intervention Prevents Use of High-Risk Medications

Prime Therapeutics initiative prevents Medicare beneficiaries from refilling high-risk medications.

Prime Therapeutics recently announced the success of their medication refill intervention program implemented among Medicare beneficiaries.

The intervention was created by the pharmacy benefit manager to prevent Medicare beneficiaries from receiving a second high-risk medication fill within a 12-month period. The program was successful in lowering high-risk medication usage among Medicare beneficiaries from 2014 to 2015, according to a press release.

The top 5 high-risk medications used among these beneficiaries were zolpidem, cyclobenzaprine, estrogens, nitrofurantoin, and amitriptyline. Preventing the overuse of high-risk medications has been an increasingly important aspect of healthcare, due to the overwhelming amount of opioid overdoses.

New legislation and programs have been created to prevent costs and adverse patient outcomes related to opioid use disorder, overdoses, deaths. The FDA has even recently launched a smartphone app competition to prevent opioid overdose-related deaths.

Controlling high-risk medication usage among elderly adults is especially important, since these patients may have a higher risk of experiencing adverse events compared with younger individuals.

A majority of patients can experience more side effects due to polypharmacy and drug-drug interactions. Researchers at Prime analyzed data from 26 of their Medicare contracts from 2014 to 2015.

Prescribers and beneficiaries in the intervention group were sent letters to discourage the use of high-risk medications, and the control group received no letters.

Included in the intervention group were 965,678 beneficiaries in 2014, and 1,131,564 beneficiaries in 2015. Included in the control group were 13,373 beneficiaries in 2014, and 52,791 beneficiaries in 2015.

Prime discovered that the intervention group’s usage rate of high-risk medications decreased from 9.9% in 2014 to 7.1% in 2015, while the control group decreased from 5.6% to 4.1%. Researchers said that the intervention group’s decrease of 1.3 percentage points more than the control group made the finding statistically significant.

Future intervention programs should focus on these 5 prevalent high-risk drugs for this population, according to Prime.

“This study shows that by bringing providers’ and members’ attention to the refilling of possible high-risk medications, behaviors may change,” said Pat Gleason, PharmD, director of health outcomes at Prime. “Keeping our members safe with the medicines they are taking is extremely important to Prime. We want to help our health plan clients bring the highest quality programs to their members, which is why we continue to implement and evaluate intervention programs such as these.”