title: Impact of a drug utilization review program on high-risk use of prescription controlled substances.
abstract: 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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daubresse
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Gleason
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Ritter
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061891:Controlled Substances / Q000008:administration & dosage* / Q000009:adverse effects; D017723:Drug Utilization Review / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D015397:Program Evaluation; D012189:Retrospective Studies; D012306:Risk; D014481:United States; D055815:Young Adult
chemical_list: D061891:Controlled Substances; D055553:Prescription Drugs
keywords: drug utilization review; pharmacoepidemiology; pharmacy benefits manager; prescription opioids