Pain Guardian Program Reduces Opioid Use

Analysis of the effectiveness of Pain Guardian, a clinical program aimed at curbing opioid abuse and waste, showed that the program significantly decreased opioid utilization, according to a poster presented at AMCP Nexus 2016. 

“According to the CDC, the driving factor for the dramatic spike in opioid-related overdose deaths is attributed to prescription opioid pain-relievers,” Patrizia Taddei-Allen, PharmD, manager of clinical operations at WellDyneRx Inc, and colleagues wrote. “The statistics are staggering: the rate of opioid related deaths in the United States has quadrupled; 78 Americans die every day from opioid overdose. Although the amount of pain reported has not increased, the number of opioid prescriptions written has nearly quadrupled since 1999.”

According to the presentation, Pain Guardian is a fraud, waste, and abuse clinical program. The researchers evaluated the effectiveness of this program by analyzing pharmacy claims data. 

Dr Taddei-Allen and colleagues conducted a retrospective study using opioid pharmacy claims data from 2014 and 2015.  Study participants included WellDyneRx members aged at least 18 years who were enrolled in a prescription plan and paid pharmacy claims for opioids. They identified opioid users and compared claims data from before and after Pain Guardian implementation for patients with utilization greater than 30, 90, and 180 days. Patients were also assigned risk scores based on a variety of factors, which were compared before and after implementation of the program. 

Study results showed that patients with at least one opioid prescription decreased by 12% between 2014 and 2015, from 3701 unique opioid utilizers to 3250 (P < .001). Furthermore, the proportion of long-term opioid users decreased significantly. Results showed that 30-day users decreased by 27%, 90-day users decrease by 36%, and 180-day users decreased by 36% (P < .001). 

The researchers also found that there was a 19% reduction in patients who exceeded the risk score target and a 19% decrease in the price per user per month.

“Using a multi-faceted and multi-pronged approach for opioid management, as opposed to a one-size-fits-all approach, results in the best patient and payer outcomes,” Dr Taddei-Allen and colleagues concluded. “Strategies, such as prior authorization, quantity level limits, pharmacy lock-in, and retrospective drug utilization review, result not only in a decrease in use of opioids, but also mitigate the number of patients exceeding an opioid risk score target.”

This study was funded by WellDyneRx Inc. —David Costill