WellManaged – Opioids Delivers Superior Clinical Outcomes and Reduced Costs

The Centers for Disease Control (CDC) attributes the dramatic spike in opioid-related overdose deaths to prescription opioid pain relievers. Opioids are commonly prescribed for pain and an estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. Ofeven greater concern is that, despite this increase in opioid prescriptions, the pain that Americans report remains unchanged. The statistics are staggering with the rate of opioid-related deaths in the United States tripling since 2000. Since 1999, there have been more than 165,000 overdose deaths related to prescription opioids. In 2014, opioid overdose deaths hit record levels, with an alarming 14% increase, according to the CDC. Opioids were involved in 28,647 deaths that year, or 61% of all drug overdose deaths in the United States. In 2017, the CDC reported a drop in the overall life expectancy of Americans (the last decrease in Americans’ life expectancy occurred in the 1960s), due to the marked spike in opioid overdose-related deaths in the last two years.

In 2014, WellDyneRx clinicians decided they needed to take steps to curb opioid abuse. They developed the WellManaged – Opioids program to help plan sponsors maintain access to these vital medications while
prioritizing patient safety and controlling costs. Through a multifaceted approach, members are managed via real-time cumulative morphine equivalent dose (MED) point-of-sale (POS) edits and prior authorizations for targeted high-risk medications. The program also leverages a proprietary risk stratification evaluation and prioritizes communications with physicians regarding at-risk members.

WellDyneRx researchers analyzed historical claims data and discovered that clients who implemented the WellManaged – Opioids program demonstrated significantly lower morphine equivalent use and a lower proportion of patients with high-risk characteristics. On average, members that were part of the WellManaged – Opioids program filled 21% less opioid prescriptions and 50% less total morphine equivalents. In addition, program participants were prescribed 26% less MEDs and had a 36% lower cost per average 30-day supply prescription. Finally, patients at the highest risk for abuse, such as those chronically on therapy or with a MED greater than 90, decreased in the WellManaged – Opioids group by 35% and 19%, respectively.

While WellManaged – Opioids was not designed as a cost-containment program, clients with the program showed a 42% decrease in PMPM when compared to clients without the program. This is likely due to improvement in clinically appropriate prescribing and opioid use exhibited by the program participants.

2018 Quarter One WellInformed Table Contents