A Prime Therapeutics, LLC, study analyzed its controlled-substance (CS) scores, which are used to identify high-risk drug use, and found a correlation between CS scores and health outcomes.
A member’s CS score is calculated through three months of a member’s CS claims, which include the number of claims, rate of CS use, number of pharmacies that filled the CS prescriptions and number of health care professionals who prescribed the CS drugs. For the study, Prime reviewed claims from 11 million commercially insured members, then examined 1 million members with a CS score of 2.5 or higher.
The results showed that a one -oint increase in CS score is correlated with the following health outcomes:
• $235 higher CS drug cost
• $1,488 higher total cost of care
• 1.5 percent increase in emergency-room visit rate
• 0.9 percent increase in hospitalization rate
Drug overdose deaths have more than doubled in the past 10 years, and over 50 percent were related to prescription drugs, the Centers for Disease Control and Prevention said.
“Controlled-substance abuse is an ongoing problem in this country,” Cathy Starner, a principal health-outcomes researcher for Prime, said. “We developed our CS score to help health plans identify and intervene with high-risk members. Validating the CS score association with health care use and costs helps quantify the potential value of an intervention.”