Prescription opioid abuse has driven drug overdoses to become the top cause of accidental death in the United States1 striking people of all ages, races and income levels throughout the United States.
The opioid crisis has become “one of the most daunting health emergencies of our time,” said Dr. Richard Migliori, UnitedHealth Group’s chief medical officer and executive vice president in an article addressing the opioid crisis.
That’s why UnitedHealthcare is committed to prevent, treat and support 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.
Since opioids come with a high risk of dependence, UnitedHealthcare helps to encourage safe and appropriate opioid use from their 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
To prevent misuse and addiction, UnitedHealthcare recently implemented several new programs to reduce inappropriate supply of opioids through supply limits on prescriptions, preventing unnecessary refills, and screening for possible unsafe combinations of opioids and other drugs prescribed to the same individual.
The new programs include:
- Setting cumulative dosage limits across all opioids to less than 180 mg MED (morphine equivalent dose) per day starting in January 2018. Members were notified 60 days in advance of the change.
- Modifying the “refill too soon” program for opioids and other controlled substances to 90 percent versus 75 percent to prevent early refills and stockpiling.
- Establishing 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 addition, 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 pain due to cancer, end-of-life or sickle cell crisis. On July 1, UnitedHealthcare will implement a program that limits opioid prescriptions through its mail-order pharmacy to a 30-day supply.
UnitedHealthcare also aims to minimize early exposure by promoting safe alternatives to opioids, aligning with CDC guidelines for opioid use, which 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; and potential for patient harm.
UnitedHealthcare offers a full spectrum of evidence based services including medication assisted treatment through our behavioral health network by treating opioid use disorder as a long-term chronic condition rather than relying on limited, ineffective short-term interventions alone. The 24/7 Substance Use Treatment Helpline can support a member to get an immediate evaluation by a licensed substance use disorder professional and access to the right care. Recovery tools and peer support provide a comprehensive and personal approach to care and can be found on liveandworkwell.com/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.
Finally, UnitedHealthcare is increasing educational efforts with all health professionals, such as doctors, dentists, behavioral health, and first responders.
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.
UnitedHealth Group is addressing the crisis. We are applying and coordinating capabilities, data and efforts across our companies, which span the spectrum of health services. Visit Our Addressing the Opioid Epidemic website for how we are taking a uniquely comprehensive approach to prevent, treat and support individuals, providers and communities.
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.