UnitedHealthcare makes a difference on the opioid front

Drug overdoses are now the number one cause of accidental death in the United States.1 This deadly crisis, striking people of all ages, races and income levels throughout the United States, is largely driven by prescription opioid abuse. 

UnitedHealthcare is committed to a program of prevention, treatment and support for patients suffering from opioid misuse or addiction. The UnitedHealth Group task force leverages resources from across the enterprise to support members and combat the opioid epidemic.

Prevent misuse and addiction

Since opioids come with a high risk of dependence, UnitedHealthcare helps to encourage safe and appropriate opioid use from the start through multiple program channels and touch points. Almost half of all opioid prescriptions are issued to patients who are new to opioids. Often these prescriptions have too many pills or too many days of therapy and are not in line with the Centers for Disease Control and Prevention (CDC) guidelines. An unnecessary supply can lead to leftover opioids in medicine cabinets, providing friends and family members with easy access. Data shows about 70 percent of misused opioid prescriptions are obtained, stolen or purchased from a friend or relative.2 

UnitedHealthcare’s approach:

  • Minimize early exposure by promoting safe alternatives to opioids, aligning with CDC guidelines for opioid use. This includes ensuring correct dosage and length of therapy, sharing data with providers and identifying outlier opioid users, prescribers and pharmacies.

    • UnitedHealthcare tracks prescriptions through proprietary technology, then reviews and takes action for:

      • Potential diversion, such as reselling a prescription.

      • Potential false medical claims, such as persuading multiple doctors to write a prescription for the same condition.

  • Reduce inappropriate supply of opioids through supply limits on prescriptions, prior authorization programs, preventing unnecessary refills and screening for possible unsafe combinations of opioids and other drugs prescribed to the same individual.

    • This year, UnitedHealthcare implemented several new procedures:

      • Set cumulative dosage limits to less than 180 mg MED (morphine equivalent dose) per day starting in Jan. 2018. Members were notified 60 days in advance of the change.

      • Modified the “refill too soon” program to 90 percent versus 75 percent to prevent early refills and stockpiling.

      • Established concurrent drug utilization review (DUR) enhancements to look for critical flags, such as use of opioids with medications prescribed for opioid use disorder or dangerous drug interactions such as opioid use with benzodiazepine or during pregnancy using prenatal vitamins as a proxy.

    • In March, UnitedHealthcare limited members new to opioid therapy (no use in the last 120 days) to a 7-day supply with a maximum dosage of 49 mg MED or less.

      • Higher doses will still be covered for certain circumstances such as cancer, end of life or sickle cell crisis.

    • In July, UnitedHealthcare is implementing a program that will limit opioid prescriptions through its mail-order pharmacy to a 30-day supply. 

  • Increase educational efforts with all health professionals (doctors, dentists, behavioral health, first responders, etc.).

Understand that opioid use disorder is a complex, chronic medical condition requiring individualized treatment

  • Connect members to evidence-based treatment and other services in their local communities, including medication-assisted treatment (MAT) programs, to help relieve opioid cravings and promote recovery.

  • Provide coverage for medications used as part of MAT. The pharmacy benefit covers Buprenorphine/naloxone and buprenorphine preferred products without prior authorization. For commercial customers the preferred buprenorphine/naloxone product is Zubsolv®.

  • Cover methadone maintenance treatment for treating opioid use disorder for fully insured and self-funded business. Methadone treatment for opioid use disorder is provided by a clinic and covered through the medical benefit.

    • Methadone maintenance and other MAT programs include a combination of medical, social, psychological and rehabilitative services. Without this treatment, there may be a 90 percent relapse rate. 

    • Methadone maintenance treatment helps those diagnosed with opioid use disorder as part of MAT and is clinically effective and cost-effective.

    • Research shows that individuals who receive MAT are 50 percent more likely to remain free of opioid misuse, compared to those who receive detoxification or psychosocial treatment alone.3

    • Combining counseling with MAT medications improves outcomes.4

  • Offer a full spectrum of services across all levels of care through our behavioral network. UnitedHealthcare treat opioid use disorder as a long-term chronic condition rather than relying on limited or short-term interventions only. In addition to MAT, these services include:

    • Support for 24/7 Substance Abuse Helpline to get members immediate evaluation and access to the right care.

    • Inpatient, residential and outpatient care.

    • Recovery tools and peer support.

  • Reduce Neonatal Abstinence Syndrome, a condition affecting newborns exposed to addictive medication prior to birth, by using data to decrease the number of opioids prescribed to pregnant women and referring members to case management for assistance.

  • Collaborate with care providers to offer members personalized care plans with access to evidence-based treatment.

  • Promote the use of naloxone to help decrease the number of overdoses. UnitedHealthcare does not require prior authorization for naloxone (injectable or nasal spray), allowing for greater access.

Support long-term recovery

Like other chronic conditions, recovery from opioid addiction requires different types of support over a lifetime. UnitedHealthcare aims to help individuals and communities heal and sustain recovery.

  • Take a “whole person” approach to address clinical, social and community influences, such as using certified peer support specialists who have recovered from substance abuse themselves.

  • Advocate for alternative treatment options for common pain conditions in accordance with clinical guidelines. UnitedHealthcare is reviewing plan designs to provide affordable alternatives to opioids for members seeking pain relief, including physical therapy, chiropractic services and acupuncture.

  • Use data and analytics to help communities get ahead of the problem, such as identifying those most at risk for addiction and helping doctors and pharmacists know when to reach out to individuals who may need support.

  • Collaborate with local care providers and community groups through the UnitedHealthcare Opioid Community Partnership to establish and drive market-specific initiatives designed to make rapid, measurable gains in the fight against opioid misuse.

24/7 Support for Members

Members can call the UnitedHealthcare Substance Use Treatment Helpline.

The toll free number is 1-855-780-5955 for information on treatment options, referrals to recovery providers, care for family members, coverage and cost of care.

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  1. Mortality in the United States, NCHS Data Brief No. 293, December 2017, Center for Disease Control and Prevention
  2. U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Sept. 2014.
  3. Calculated by Optum, based on relative risk ratios from the meta-analysis in: Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011117. DOI: 10.1002/14651858.CD011117.pub2, pages 17 and 19.
  4. In terms of significantly reducing treatment dropouts, use of opiates during treatment, use of opiates at follow-up, and absences during treatment, as reported in Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD005031