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OptumRx opioid risk management program to go nationwide

Interventions lead to fewer prescriptions, less opioid consumption by aggressively limiting opioid dose and duration of therapy.

Susan Morse, Associate Editor

An OptumRx risk management program that has shown such successful results at reducing opioid consumption and prescribing is being rolled out nationwide.

The opioid risk management program places maximum fill limits on opioid therapy, whether the patient is new to opioids or a chronic user, according to OptumRx, which is Optum's pharmacy care services company and is part of UnitedHealth Group.

[Also: Secret weapon: UnitedHealth's Optum business is laying waste to old notions about how payers make money]

The program uses point-of-service interventions in prescribing, dispensing and consumer use to reduce inappropriate consumption  and to increase alignment with Centers of Disease Control guidelines, according to OptumRx.

OptumRx is able to initiate the interventions by leveraging its clinical, analytics and administrative services and its connections to patients, providers and pharmacists. It aggressively limits opioid dose and duration of therapy at the initial first fill in alignment with updated CDC prescribing guidelines and generating prompt first-fill member education.

Since launching the program on July 1 with more than 400 clients, the prescriptions above the CDC guideline of recommended daily morphine equivalent dose have decreased by 82 percent.

[Also: Opioid overdose study from Beth Israel Deaconess researchers spotlights crushing burden on hospitals]

The program has reduced by 65 percent prescriptions for first-fill acute opioid treatment written above the maximum 7-day supply.

It has decreased by 68 percent prescriptions for current chronic opioid utilizers issues for a greater than 90mg morphine equivalent dose.

It has also reduced by 14 percent the average dose across all opioid prescriptions.

"OptumRx's program is showing early but meaningful potential to begin curbing the opioid epidemic in America," said Sumit Dutta, MD, chief medical officer of OptumRx. "We expect these improvements to continue as the program gains momentum and we implement with more clients."

"The results of opioid risk management show that through coordinated efforts across the entire spectrum of patient treatment, we can make changes that help provide better health outcomes for patients and for society as a whole," said David Calabrese, chief pharmacy officer at OptumRx.

OptumRx's approach uses a connected clinical strategy includes applying evidence-based utilization management protocols after first fill to reduce excessive dosing, limit unnecessary extension of therapy duration, mitigate abuse and diversion, and decrease exposure to harmful drug combinations through real-time medication checks at the point of sale.

It uses analytics for enhanced physician prescribing monitoring, pharmacy dispensing surveillance and auditing, and intensive case management for plan participants who are at high risk.

The program identifies patients with current or previous overdose, dependence and/or confirmed opioid use disorder and uses evidence-based best practice treatment guidelines, advanced patient monitoring, support and relapse prevention.

"Recognizing this is an issue that can affect any segment of our population at any point in time, successful opioid management programs must tailor engagement based on the needs of an individual," said Calabrese. "The right level of prevention and care must be delivered, at the right time, to the right stakeholder – using multiple channels and touchpoints – before a member even receives a first opioid prescription through to the effective support and management of those well entrenched in battles to fight this devastating epidemic.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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