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Impact of a drug utilization review program on high‐risk use of prescription controlled substances
Author(s) -
Daubresse Matthew,
Gleason Patrick P.,
Peng Yi,
Shah Nilay D.,
Ritter Stephen T.,
Alexander G. Caleb
Publication year - 2014
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3487
Subject(s) - medicine , pharmacoepidemiology , medical prescription , drug , prescription drug , drug utilization review , intensive care medicine , environmental health , pharmacology
Background Prescription drug abuse has prompted considerable concern. We evaluated a retrospective drug utilization review program to reduce controlled substance use among individuals with high‐risk utilization. Methods We analyzed pharmacy claims from a large pharmaceutical benefits manager. For each eligible member, we calculated a controlled substance score based on the number and type of claims, prescribers and pharmacies, and utilization patterns over three months. Two state health plans sent controlled substance letters to prescribers of members meeting or exceeding a plan‐ and pre‐specified controlled substance score. Two different state health plans did not send such letters. We used a difference‐in‐difference design and generalized estimating equations to quantify the impact of the program on the mean difference in reduction of the controlled substance score over six months. Results Eligible members in the intervention and comparison states had similar baseline mean controlled substance scores (19.0 vs. 18.6, p = 0.36). Adjusting for individuals' age, sex and pharmacy risk group score, reductions in the mean controlled substance score were greater in the intervention than comparison cohort (5.67 vs. 4.31, p = 0.01), corresponding with a 34.0% reduction in the intervention cohort compared to a 25.5% reduction in the comparison cohort. Changes were driven primarily by reductions in the number of controlled substance claims filled (30.5% vs. 23.1%, p = 0.01), as well as by a non‐statistically significant trend towards reductions in the number of prescribers and pharmacies used (26.9% vs. 20.1%, p = 0.07). Conclusions Retrospective drug utilization review programs may reduce controlled substance scores and claims among individuals with patterns suggesting high‐risk utilization. Copyright © 2013 John Wiley & Sons, Ltd.