Opioid abuse is a national epidemic: every 13 minutes there is an opioid-related death. Between 2015 and 2016 drug overdoses increased 21%, according to the Centers for Disease Control. Our prescription drug vendor, OptumRx, uses an innovative opioid management program that helps members and patients balance the need for powerful medications with the risk of abuse and misuse. Targeted drugs include Oxycodone, hydrocodone, morphine, hydromorphone, codeine, fentanyl, methadone, tramadol, OxyContin, Percocet, Lorcet, and Vicodin. The program takes a multi-pronged approach to help tackle abuse:
- Prevention and education: OptumRx provides education to patients and providers about the risks of opioids. Home delivery patients who fill opioid prescriptions through mail order receive education and promotion of proper leftover drug disposal. The drugs our dispensed with label and bottle cap warnings about the drug risks.
- Minimize early exposure: Opioid abuse can start in a few days, according to a March 2017 HealthDays study, so it’s important to limit the dose and duration of these highly addictive medications. Using a combination of quantity limits and prior authorizations, the program minimizes early exposure and duration of therapy. Clients who adopted this program experienced a 31 percent decrease in opioid prescription volume.
- Reduce inappropriate supply: Optum Rx employs first-fill dose and duration limits for patients not receiving opioids on a daily basis. Program results show a 50 percent lower likelihood of patients progressing from short-term acute use to longer-term chronic opioid use after the first fill.
- Treating at-risk and high-risk members: After identifying patients at risk for opioid abuse, Optum Rx collaborates with prescribing physicians to prevent progression to chronic use.
- Supporting chronic populations and recovery: Patients who have had an overdose experience or have been identified as opioid dependent are prescribed medication assisted therapy. These patients are monitored and supported to help with relapse prevention.
Since program inception in 2017, OptumRx has significantly boosted compliance with CDC clinical best practice opioid prescribing guidelines: 96 percent of opioid prescriptions are aligned with dosage and duration guidelines compared to the 55 percent national average.
The Pharmacy Benefit Management Institute (PBMI), the nation’s leading provider of pharmacy research and education to help design prescription drug programs, recently recognized OptumRx for its comprehensive initiative addressing the opioid epidemic. Optum Rx received the PBMI 2019 Excellence Award for Opioid Management Strategies on March 5, 2019.
To take advantage of this award-winning program effective January 1, 2020, and for detailed program costs, contact the OptumRx edHEALTH team.