What Strategies do PBMs Use to Control Spend on Prescription Opioids?


Jon Gavras, MD, chief medical officer at Prime Therapeutics, lists the strategies pharmacy benefit managers use to reduce spending on opioids.

Gavras: I mentioned earlier that we have looked at members that have a high number of prescriptions that are prescribed for them in the narcotic class. We then can go back to the prescribers and work with them directly.

In addition, we’ve done an analysis recently—and we’ve written this up—around folks that are on benzodiazepines and narcotics, like opioids, at the same time. What we’ve found that is 9 out of the 10 folks that are likely taking too much opioids or overusing opioids are also on a benzodiazepine. That’s 9 out of 10 times.

So, we’ve really been able to interact with the prescribing physicians on that and working with other various mechanisms to help get these members better managed and overall reduce the number of prescriptions.

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