OptumRx initiates Opioid Restriction Program following Express Scripts and CVS Caremark’s Lead

OptumRx, a Pharmacy Benefit Manger (PBM) owned by United Healthcare, has implemented a new opioid restriction program with policies and procedures to curb opioid dispensing. According to the OptumRx website, “Opioid misuse and abuse is a national health crisis—drug addiction is now the leading cause of accidental death.” Much like its PBM counterparts Express Scripts and CVS Caremark, OptumRx’s new program places maximum fill limits on opioid therapy, regardless whether the patient is new to opioids or a chronic user. The program also uses point-of-service interventions in prescribing, dispensing, and consumer use in order to try to reduce inappropriate consumption and align with the new Centers of Disease Control (CDC) guidelines.

Additionally, OptumRx is utilizing a clinical strategy comprising pharmacy clinical capabilities and Optum analytics by targeting five key factors contributing to the current epidemic including:

  • Prevention and Education
  • Minimizing Early Exposure
  • Reducing Inappropriate Supply
  • Treating plan Participants who are at Risk and High Risk
  • Supporting Chronic Populations and Recovery

Since launching the program with more than 400 clients on July 1st, OptumRx reports that there has been an 82 percent decrease in prescriptions above the CDC guidelines recommended dose of 50 mg Morphine Equivalent Dose (MED) per day for first-fill acute prescriptions. They also report the program has reduced prescriptions for first-fill acute opioid treatment written above the maximum 7-day supply by 65 percent. 

With much of OptumRx’s website and resources now dedicated to the national opioid epidemic, and notwithstanding any controversy that may arise from the new OptumRx program, it is clear that changes to the healthcare system will continue to take place in order to find new and effective ways to combat the national opioid epidemic. As the healthcare spear continues to evolve over time, healthcare providers must continue to quickly adapt to these changes in order to provide the appropriate care to their patients. This may require healthcare providers to further educate themselves, implement new training of staff, write new policies and procedures, and implement new operational processes. 

For more information on OptumRx’s new program or if you are a physician or pharmacy that would like to discuss what OptumRx’s new program may mean for you, or if you would like assistance implementing an opioid compliance program, contact Frier Levitt today to speak to an attorney.

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