Optum’s Efforts Combat Opioid Misuse and Abuse


Carl Black, pharmacist-in-charge at Optum Rx, talks about how the PBM has decreased dispensed opioids by 62% since 2018.

The COVID-19 pandemic has brought increased economic, physical, and psychological strain to many Americans and coincided with an increase in opioid overdose deaths, according to a recent study published in the Journal of Urban Health.

Carl Black

Carl Black

“The increase in opioid overdose deaths during the pandemic has been attributed to various factors: reduced access to interventions, increased levels of stress due to isolation and loss of mental health support, and changes in the types/combinations and purity of drugs and patterns of drug use,” Carl Black, pharmacist-in-charge at Optum Rx, told Formulary Watch.

To address misuse of opioids, Optum Rx provides services and solutions that help prevent fraud, promote better prescribing accuracy, reduce drug errors, and align with state and federal pharmacy laws. “Our mission is to get out in front of misuse, abuse, dependence and medication sharing before it starts,” Black said.

Addressing opioid use and abuse has been a priority for many PBMs and health plans. For example, a pilot intervention program developed by Prime Therapeutics saw decreased opioid claims and lower morphine milligram equivalents for Medicare members who were at high risk of overusing opioids.

Related: Prime Therapeutics Reduces Opioid Claims with Targeted Intervention

Optum Rx’s Opioid Risk Management is a comprehensive solution for opioid management and prevention. Since 2018, Optum Rx’s opioid management program has resulted in a 62% reduction in total opioid quantity.

Optum Home Delivery implements specific requirements for opioid medications dispensed, including warning caps and labels, limiting quantities to a 30-day supply, and using an ePrescribing requirement. The home delivery program employs 1,200 pharmacists and pharmacy technicians on staff that are available 24/7. The program was recently awarded the URAC Opioid Stewardship Designation for excellence in quality care for opioid prescriptions. It is the first accredited mail order pharmacy to earn this designation.

“What many people may not realize is that home delivery offers a far more intensive clinical management environment than the typical retail setting,” Black said. “Our consulting pharmacists spend 70% of their time with patients vs. 10% of time spent with patients in a retail setting. Home delivery members with chronic illness are more likely to be filling and taking long-term medications. Our average adherence was 20% higher with home delivery than for retail. This has shown to improve health outcomes and reduce other associated medical costs.”

Stemming the tide of opioid deaths means closely managing how much opioid is available to each patient, Black said. The current CDC guidelines approach this by promoting what are called “morphine-milligram” dosing equivalents (MMEs). This is a numerical standard that compares the relative potency of different opioid drugs, which in turn makes it easier to evaluate how much risk each patient faces.

Additionally, Black said Optum Rx has procedures in place that exceed state requirements for filling opioid prescriptions. Pharmacists and team members review patient profiles and history, such as taking more than three to five medications; prescriber practices and habits; and differing state mandates.

Optum, he said, is positioned to address this crisis by connecting efforts across the entire health system and continuum of care. “We start with preventing opioid misuse and addiction by educating care providers and individuals on the proper use of opioids, promoting alternative treatments for pain, advancing best practices for prescribing and using these highly addictive medications — and intervening when needed — in a way that protects the individual’s privacy,” he said. “We collaborate with providers to make sure individuals struggling with opioid use disorder are connected to evidenced-based treatment in their local communities and have personalized support for long-term recovery.”

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