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UnitedHealthcare Addresses Increased Opioid Use and Dependence

March 3, 2017

For more than a decade, UnitedHealthcare has been investing in multi-dimensional programs to reduce the abuse of opioids while providing patients with both temporary and chronic pain access to the safe and effective treatment they need – including non-opioid options. We have a number of programs and policies in place to prevent the misuse of opioids, and provide quick and appropriate access to opioid addiction treatment.

Our efforts have made a tangible impact on reducing the potential over-prescribing and overlap of opioid treatments. Consider the following trends among our commercial health plan members in 2015 alone, based on use of our Retrospective Narcotic Overutilization program:

  • 41% decrease in the number of opioid prescriptions written
  • 45% decrease in the number of physicians prescribing opioids
  • 41% decrease in the number of pharmacies dispensing opioids  

Our work is far from done. UnitedHealthcare continues to invest resources into programs aimed at both the prevention and treatment of opioid addiction, taking into account the CDC’s latest recommendations

Quick Access to Treatment
Effective March 1, 2017, prior authorization has been eliminated for preferred medications on UnitedHealthcare’s commercial Prescription Drug Lists (PDLs) that are used to treat opioid dependence, including buprenorphine and Zubsolv. Naloxone, which is used to treat opioid overdose, is already covered without prior authorization. 

Prevention
Using our deep analytics capabilities and data, we are able to help identify individuals who may be at risk earlier in the progression of this disease so that intervention can occur sooner and adverse outcomes be reduced. For example, for the past 10 years UnitedHealthcare has expanded its Retrospective Narcotic Overutilization programs that identify members who are at increased risk of opioid dependence due to a high number of prescriptions from multiple doctors and pharmacies - allowing a coordinated and holistic approach to prescribing patterns. 

UnitedHealthcare also utilizes a “Pharmacy Lock-In” program to create a coordinated view of prescribing patterns. Once enrolled in this program, members must obtain their prescriptions from a single pharmacy, reducing the likelihood of overprescribing or conflicting prescriptions. Members are identified for the “Lock-In” program through physician referrals, our Retrospective Narcotic Overutilization program, and medical director referrals. 

And through our drug utilization review process, we can identify members who have started opioid dependence therapy to reduce their reliance on opioids, but continue to receive an opioid medication from their physician. This important step allows us to proactively notify physicians about a possible relapse, and encourage intervention. 

Proactive Interventions and a Whole Person Approach
UnitedHealthcare provides benefits coverage for medication assisted treatment so that people who develop opioid dependence can receive the support they need.

 Patient support is among the most important services we can provide for individuals fighting addiction. UnitedHealthcare provides access to a free, confidential patient substance use and treatment helpline with specialized clinicians who provide treatment advocate services 24 hours a day, 7 days a week. We also have the largest network of medication assisted therapy providers and are actively integrating medical, behavioral and pharmacy treatments to enable a holistic, whole-person approach to reducing opioid abuse and dependence. 

UnitedHealthcare will continue to educate its members about the opioid epidemic as well as available treatment options and local care providers who they can turn to for support. Our dedicated web site answers commonly asked questions and provides access to help with a single click or call – www.liveandworkwell.com/recovery

Below are additional public resources about the opioid epidemic and treatment of chronic pain.

January 1, 2018 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2018. Learn more

New Sales Automation Management Tool


Check out our new Sales Automation Management (SAM). Learn more

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