Targeted Support: Opioid Case Study

Pain affects millions of Americans and contributes to morbidity, mortality, and disability. Pain is associated with enormous costs both at the direct economical level and indirectly by reducing members’ quality of life. Older patients are more likely to receive long-term and multiple drug prescriptions, which could lead to improper and/or non-optimal use of medications, especially when treated with opioid pain medications.

The Opioid Quality Improvement Initiative:

  • increases member awareness of opioid unintentional misuse and potential and
  • provides statistical data to help identify at-risk members and to mitigate risk associated with opioid use and unintentional misuse.

Initiative Elements:
A website for Plan members addressing opioid use and potential misuse.
Website content and format specifically targeting older adults is available. Messaging includes the benefits and harms associated with opioid use, facts about the use of opioid medications, patient cases addressing some issues associated with opioid use (tolerance, addiction, dependence, and diversion or illicit use), and information on the improper use of opioid medications. Members are made aware of this website through printed collateral distributed by TRHC or the Plan. Website has Q&A feature for members to query TRHC expert clinical pharmacists.

Communication to Plan opioid user members about the Initiative and proposed benefits.
Member communications are developed in conjunction with the Plan, and distributed. Number and frequency of mailers is dependent upon response rate. Messaging includes the benefits and harms associated with opioid use, facts about the use of opioid medications, patient cases addressing some issues associated with opioid use (tolerance, addiction, dependence, and diversion or illicit use), and information on the improper use of opioid medications.

Population-based risk analysis and stratification based on prescription claims data.
Plan members are analyzed and stratified into risk categories using TRHC’s proprietary medication risk stratification software. Progressing from low to major Risk, the members are assigned to relative risk groups (low, moderate, high, very high, and major risk). Factors contributing to this score include number of medications, competitive inhibition score, sedative burden, heart rhythm risk, and more.

Member risk characterization of drug use profile in opioid and non-opioid users.
Using claims data, Plan members are characterized according to overall opioid use risk. Profiles of prescribed medications are analyzed in opioid vs. non-opioid members to establish trends of drugs associated with conditions and consumption. These analyses also show the most frequently prescribed opioids, so that prevalence of drug-gene interaction risk can be evaluated.

Evaluation of drug use profile among CYP2D6 opioid-treated individuals.
Concomitant administration of CYP2D6 opioids and other medications that require CYP2D6 to be activated or eliminated is analyzed. (Other CYP2D6 medications effectively render that gene unavailable to activate the opioid, so members on competing CYP2D6 drugs may feel reduced or diminished pain relief.) TRHC pharmacists perform detailed assessments of member medication profiles to determine which drug-gene interactions are clinically significant, and which members would benefit from an intervention.

Assessment of patterns of opioid unintended misuse and abuse.
Patterns indicating potential opioid problems are identified, including but not limited to:

  • Multi-opioid users receiving opioid prescriptions from more than one prescriber
  • Number of pharmacies dispensing opioid medications by member
  • Multi-opioid users receiving opioid prescriptions from prescribers located in more than one state

Drug profiles of members taking more than one opioid are reviewed by TRHC clinical pharmacists and categorized as Likely to have opioid drug abuse, having Potential for opioid drug abuse, and Not likely to have a potential for opioid drug abuse.

Contact us for more information about this and other Targeted Support Initiatives.