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Reducing Opioid Utilization, Costs Through Provider Outreach, Coordination

October 19, 2020

Study findings from a poster presented at AMCP Nexus 2020 suggest that when providers perform outreach and coordination across both prescribers and patients, opioid utilization and costs are reduced.

“In 2016, the Centers for Disease Control and Prevention (CDC) published its Guideline for Prescribing Opioids for Chronic Pain to improve communication between clinicians and patients in regards to the following: the risks and benefits of opioid therapy for chronic pain, the safety and effectiveness of pain treatment, and the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death,” the researchers wrote. “In support of the CDC guidelines, an enhanced Opioid Program to reduce opioid overutilization through coordination of care between prescribers was implemented in 2018.”

Among a commercially insured and Medicaid insured population, the study authors aimed to understand the effect provider and patient education had on opioid utilization and cost. They used pharmacy claims data to help identify patients for the study. The participants had to meet the following:

  • use of opioids with a morphine milligram equivalent (MME) of  90 mg for 90 days;
  • > 3 opioids / > 3 prescribers/ > 3 pharmacies or > 5 prescribers; 
  • use of benzodiazepines, carisoprodol, +/- gabapentinoids and 90 MME/day of opioids; and
  • overlapping use of opioids and opioid dependence medications for 30 days.

In addition to meeting these criteria, patients with pharmacy benefits 5 months before and after intervention were evaluated, and the utilization outcomes, including average MME and opioid costs, were measured.

Of the 1985 patients who met program eligibility, the researchers observed a reduction of 28 mg (95% CI 25, 31) in average MME. Additionally, the researchers found that the average reduction in was opioid pharmacy claims cost was $271.03 (95% CI $216.10, $325.95).

Further findings show that 581 participants (30%) no longer met program criteria of >90 mg of MME. The authors also noted that the number of participants utilizing multiple pharmacies and prescribers dropped from 98 at baseline to 14 post intervention.

“Provider outreach and coordination across prescribers and patients reduced opioid utilization and cost,” they concluded. “A future enhancement to the program may entail case management of patients continuing to meet high MME utilization.”

Julie Gould 


Ara S, Vu J. Change in Opioid Utilization across Multiple Lines of Business in a Managed Care Organization. Poster U7. AMCP Nexus 2020.

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