According to our PCMA mission statement, our purpose is to “inform, serve, advocate and advance”…
Addressing the Opioid Epidemic
By Dr. Christine Laramee
As physicians, you’ve likely seen firsthand the sweeping effects of opioid misuse. According to the Florida Department of Health, there were more than 750 heroin-related deaths in our state in 2015, and 80 percent of heroin users misused prescription pain medications before using heroin.
Recent state policy changes and the introduction of Florida’s Prescription Drug Monitoring Program, E-FORCSE®, have had a positive impact on decreasing opioid misuse locally. UnitedHealthcare, as one of the state’s largest health insurers, is also addressing the opioid epidemic. Working directly with care providers, the government and patients, we’re investing in programs to reduce the overuse of opioids, help prevent misuse before it starts, and give our members quick access to needed treatments for opioid dependency.
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. These statistics are based on members identified through 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
Because this crisis is impacting communities across the country, we want share some of our strategies that have shown effectiveness in addressing it.
We’ve used our data and analytics capabilities to help identify individuals who may be at risk so intervention can occur sooner and adverse outcomes may be reduced. For example, our Retrospective Narcotic Overutilization programs identify members who are at increased risk of opioid dependence due to a high number of prescriptions from multiple doctors and pharmacies – allowing a more coordinated and holistic view of prescribing patterns.
UnitedHealthcare also uses a “Pharmacy Lock-In” program to review prescribing patterns for members identified through our Retrospective Narcotic Overutilization program or physician and medical director referrals. Members enrolled in this program must get their prescriptions from a single pharmacy, reducing the likelihood of overprescribing or conflicting prescriptions.
And through our drug utilization review process, we identify members who have started opioid use disorder therapy to reduce their reliance on opioids but continue to receive an opioid medication from one or more prescribers. This important review helps us proactively notify physicians about 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 use disorder 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.
Quick Access to Treatment
Prior authorization is not required for preferred medications on UnitedHealthcare’s commercial Prescription Drug Lists (PDLs) that are used to treat opioid use disorder (buprenorphine and Zubsolv). Naloxone, which is used to treat opioid overdose, is also covered without prior authorization.
UnitedHealthcare continues to invest resources into programs aimed at both the prevention and treatment of opioid addiction, taking into account the latest recommendations from the Centers of Disease Control and Prevention (CDC).
Christine Laramee, MD is a medical director at UnitedHealthcare in Florida. Before joining UnitedHealthcare, she owned a solo practice of family medicine and wellness in Pinellas County, and served as medical director at The Hospice of the Florida Suncoast for ten years. She is board certified in family medicine, hospice and palliative care and received her medical degree from Universite de Montreal.