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Navitus Debuts Predictive Tool to Prevent Opioid Misuse

  • Jul 22, 2021
  • PBM Model

As appeared in AIS Health’s RADAR on Drug Benefits on July 22, 2021

COVID-19 presented the health care system with many challenges in 2020, but one of the most sobering was the impact on opioid misuse.

The Centers for Disease Control and Prevention (CDC) said earlier this month that more than 93,000 Americans died from a drug overdose in 2020. This represents a 29% increase compared to 2019. Only two states, New Hampshire and South Dakota, reported a decrease in drug overdose deaths.

According to CDC data, opioids represent the largest percentage of drug overdose deaths in 2020, at nearly 70,000. Meanwhile, a recent National Institute on Drug Abuse analysis estimated that more than 20% of these deaths involved prescription opioids. Beyond the increase in overdose deaths, a recent American Medical Association report concluded that every state faced concerns about access to care for substance use disorder and harm-reduction services in 2020.

Against this sobering backdrop, the PBM Navitus Health Solutions has added a predictive analytics product to its Opioid Safety Solutions offering. The product, Predictive Analytics for the Misuse of Opioids (PAMO), generates member-specific risk scores to help prescribers identify who may be at risk of opioid misuse and recommend non-opioid treatment options.

“We always strive to do the right thing, and clearly opioid use and misuse is an epidemic,” Julie Olson, vice president of clinical innovation at Navitus, says in an interview with AIS Health, a division of MMIT. “We’re not at the bedside, but this allows us to support our health plan clients and have actionable information at the point of care, wherever and whenever possible.”

While the PAMO product can conduct retrospective analyses such as script volume, Olson says the product’s real value is in enabling prescribers to take proactive measures to prevent a prescription from being written in the first place.

Tool Accounts for Social Determinants
PAMO pulls data from a range of clinical claims and pharmaceutical sources to produce a risk score. These include morphine milligram equivalency, the presence of prescription combinations such as opioids and benzodiazepine, medical diagnoses such as mental health conditions or a history of substance use disorder, and the number of pharmacies and prescribers that have given prescriptions to a patient.

“We know that health plans and providers don’t have access to all prescriptions across their patients. They don’t know who could be getting prescriptions from multiple places,” Olson says.

In addition, PAMO incorporates data that reflects social determinants of health, including ZIP code, income and education level.

The product then puts the data through what Olson describes as a weighted analysis. This assigns a risk score to individual members as well as identifies and stratifies members into groups based on their risk factors.

PAMO does not provide specific recommendations, as Olson says Navitus recognizes that each health plan and provider offers a range of established services for addressing opioid misuse. “We support the medical home model. We know the system knows the patient best.”

Instead, Navitus' goal is to empower customers to provide personalized and coordinated care for patients who are identified as at risk. For one customer, the next step may be a referral to a provider who specializes in patients at risk of opioid misuse. Another may recommend a complex care management program. Another may consider non-opioid therapies or pain management techniques.

PAMO Focuses on Prescribers
PAMO emphasizes a proactive approach by targeting those who write prescriptions at the point of care as opposed to those who fill them, Olson says. Supporting this approach aligns with Navitus' mission as a pass-through PBM, she adds.

“It’s ingrained in who we are. We have aligned incentives, and that starts with the data,” Olson says. “We use data to make all our clinical decisions — and we use the same analytics systems that our clients have access to, so we have the same single source of the truth.”

The PAMO product aligns with two existing initiatives at Navitus.

The first initiative is Navitus' Predictive Analytics Reporting, which looks at a member’s claims data to determine risk of medication nonadherence. By examining factors such as number of prescriptions, late refills and social determinants, Navitus has been able to predict future non-adherence at a rate of more than 95%, the company said.

The second initiative, Opioid Safety Solutions, promotes appropriate and safe use of opioids. These offerings include alerts to pharmacists if a member is concurrently using opioids, muscle relaxants and sedative hypnotics; time and dosage limits for opioids and other potentially unsafe prescriptions; and retrospective monitoring of member prescriptions for controlled substances. According to the company, these programs have resulted in smaller supplies of opioid prescriptions, increased adherence to appropriate use guidelines and increased reports of suspicious activity such as multiple opioid prescriptions.

Navitus Acquired Two Firms
In addition to announcing the release of the PAMO product, Navitus Heath Solutions this week announced two acquisitions:

Navitus has acquired EpiphanyRx, a Brentwood-Tenn.-based full-service PBM that focuses on the mid-market employer segment. EpiphanyRx offers co-pay assistance, specialty drug management programs and technology platforms.

Lumicera Health Services, the company’s wholly owned specialty pharmacy, has acquired Quality Drug Clinical Care, an Irvine, Calif.-based specialty pharmacy that serve patients with HIV.

Financial terms of the transactions were not disclosed.

Contact Olson via Tricia Dutton at


Copyright © 2021 by AIS Health, a division of Managed Markets Information & Technology, LLC. Reprinted with permission from AIS Health, an MMIT company,

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