Reducing opioid use disorder
Program Reduces Risk for Enrollees of Developing Opioid Use Disorder
Pharmacy is a key component of integrated care coordination and our pharmacy benefit management’s Controlled Substance Utilization Monitoring (CSUM) program identifies Enrollees at risk of substance use disorder or other harm. This includes receiving multiple controlled substance medications and/or at high dosages, or filling opioid prescriptions from multiple Providers at multiple pharmacies.
The CSUM program helps to coordinate care and reduce risk of opioid substance over-utilization and results in decreased high-dose opioid use, as well as decreased utilization of multiple prescribers or pharmacies. The CSUM program also reduces fraud and waste.
Results from 2020 for our DC Enrollees include:
- 70% of eligible Enrollees discontinued or lowered their dosage of opioid medication
- 50% of eligible Enrollees discontinued use of multiple opioid prescriptions from multiple providers
- 68% of eligible Enrollees with 10 or more claims for controlled substances reduced their utilization for these medications to less than 10 at 180 days post-intervention
- 55% of eligible Enrollees discontinued use of harmful combination of opioids, benzodiazepines and muscle relaxants