OBJECTIVES: Estimate the potential impact of opioid analgesics formulated with tamper resistant technologies (TRT) on drug acquisition and abuse treatment costs in a managed health plan through a budget impact model. METHODS: A model was developed to determine the impact of TRT therapy on opioid drug costs and abuse treatment costs for a hypothetical health plan of 1 million members.   Claims analysis from the Thomson Reuters Commercial Encounters and Medicare Supplemental database was used to obtain the number of patients on low dose oxycodone therapy, annual days supply, prevalence of opioid abuse and annual abuse-related treatment costs.   Patient willingness to continue TRT therapy was obtained from a clinical trial.  Patients continuing TRT therapy were assumed to be non-abusers.  Pricing assumptions were $2.67 (WAC) for a newly approved immediate release TRT and $0.16 for generic low dose oxycodone.    A sensitivity analysis addressed the percentage of abusers placed on TRT therapy. RESULTS: Opioid abuse prevalence for patients on low dose oxycodone was 1.8%. Mean annual opioid abuse-related medical costs were $5,325.   Mean annual days supply for patients with abuse claims was 169 days versus 40 days for patients with no claims.  Thirty percent of patients were not willing to continue TRT therapy.  With 20% of abuse patients placed on TRT therapy gradually over 24 months, WAC drug acquisition costs increased 0.6% ($221,697 vs. $217,321) for the plan, while abuse treatment costs decreased 1.8% ($500,993 vs. $510,280) and total drug and treatment costs decreased 0.7%.  With all abuse patients placed on TRT therapy, while there was a 3% increase in drug costs, there was a 9.1% reduction in abuse treatment costs and a decrease in total drug and treatment costs of 3.4%. CONCLUSIONS: TRT for patients with history of opioid abuse can potentially result in savings in abuse treatment costs and overall cost reductions.