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OptumRx Receives Pharmacy Benefit Management Institute’s Excellence Award for Opioid Risk Management

OptumRx has received the 2019 Excellence Award for Opioid Management Strategies from the Pharmacy Benefit Management Institute. The award recognizes OptumRx for significantly reducing excessive prescribing, dispensing and consumption of prescription opioids – while delivering quality care – through its Opioid Risk Management program, a comprehensive initiative addressing the opioid epidemic.  

Since the program’s launch in July 2017, OptumRx has successfully helped clients and patients balance the need for these powerful medications with the risk of abuse and misuse.

  • Reducing the opioid supply: Clients who adopted short-acting opioid utilization management criteria experienced a 31 percent decrease in opioid prescription volume and a 42 percent decrease in the total morphine milligram equivalent (MME) exposure among patients receiving opioid prescriptions.
  • Decreasing progression from acute to chronic use: Clients who adopted first-fill dose and duration limits for patients not receiving opioids on a daily basis showed a 50 percent lower likelihood of these patients progressing from short-term acute use to longer-term chronic opioid use after the first fill.
  • Improving clinical best practices: In line with the Centers for Disease Control and Prevention’s recommended best practices for prescribers, 96 percent of opioid prescriptions among Optum customers who adopted the program were in full alignment with dosage and duration guidelines, vs. 55 percent national average. 

“Using advanced data analytics and evidence-based clinical strategies, we are mitigating opioid misuse and abuse before it starts, while supporting people who may be battling dependency and addiction issues, as well as those in recovery,” said David Calabrese, chief pharmacy officer at OptumRx. “We are honored to be recognized by PBMI for the positive impact we are having on the patients and clients we serve.”

The OptumRx Opioid Risk Management program extends beyond what traditional, stand-alone pharmacy benefit organizations can address by targeting five key factors contributing to this complex health care crisis, including:

  • Prevention and education: Educating all stakeholders regarding risks, proper dosing/duration, storage, safer treatment alternatives and proper disposal.
  • Minimizing early exposure: Limiting opioid dose and duration of therapy at first fill.
  • Reducing inappropriate supply: Applying protocols to reduce excessive dosing, limit unnecessary extensions, mitigate abuse and decrease exposure to harmful drug combinations.
  • Treating atrisk and high-risk members: Preventing progression to chronic use, abuse and dependence through intensive, multidimensional program efforts.
  • Supporting chronic populations and recovery: Guiding patients with current or previous overdose experience/dependence issues/opioid use disorder and providing advanced patient monitoring, support and relapse prevention.

“OptumRx’s Opioid Risk Management program stands apart because of its dual focus on reducing both the consumption and prescription of opioids, enabling the company to achieve unparalleled results on both fronts,” said Jane Lutz, executive director of PBMI. “Knowing that OptumRx is continually updating the program to advance positive results for its members, we look forward to the work that is to come.” 

OptumRx is continuing to expand its efforts to curb the rise of opioid abuse through a variety of new components recently launched and in development, including:

  • More aggressive first-fill dose and duration limits (3 days; 50mg/day) for children and young adults;
  • Decreased opioid dispensing through OptumRx Home Delivery Pharmacy to a maximum of 30-day supply only, which helps reduce excess supply and supports safe and appropriate opioid use; and
  • Adherence monitoring and intervention for patients on medication assisted therapy.

For more information on OptumRx’s Opioid Risk Management program, visit our resource page.