OptumRx Opioid Risk Management Program Leads to Better Outcomes for Patients and Clients

August 22, 2017
  • New program significantly reduces inappropriate consumption, dispensing and prescribing of prescription opioids
  • Opioid Risk Management Program launching nationwide after initial success

OptumRx today announced the initial results of its Opioid Risk Management program, which is reducing opioid consumption and prescribing and will be rolled out nationwide to build on its early success.

The Opioid Risk Management program identifies the most significant points in the prescribing, dispensing and consuming process for intervention and education to reduce inappropriate use and increase alignment with Centers of Disease Control (CDC) guidelines. The program also places maximum fill limits on opioid therapy, whether the patient is new to opioids or a chronic user.

Since launching the program with more than 400 clients on July 1, these point-of-service interventions have delivered the following improvements:

  • 82 percent decrease in prescriptions above the CDC guideline recommended dose of 50mg morphine equivalent dose (MED) per day for first-fill acute prescriptions;
  • 65 percent decrease in prescriptions for first-fill acute opioid treatment written above the maximum 7-day supply;
  • 68 percent decrease in prescriptions for current chronic opioid utilizers issues for >90mg MED; and
  • 14 percent reduction in average dose across all opioid prescriptions.

"OptumRx's program is showing early but meaningful potential to begin curbing the opioid epidemic in America," said Dr. Sumit Dutta, chief medical officer of OptumRx. "We expect these improvements to continue as the program gains momentum and we implement with more clients."

By leveraging OptumRx's clinical, analytics and administrative services and its deep connections to those who can effect change – patients, providers and pharmacists – the company is uniquely positioned to help address the opioid epidemic.

David Calabrese, chief pharmacy officer at OptumRx, said, "The results of Opioid Risk Management show that through coordinated efforts across the entire spectrum of patient treatment, we can make changes that help provide better health outcomes for patients and for society as a whole."

OptumRx's approach uses a connected clinical strategy comprising pharmacy clinical capabilities and Optum analytics, as well as care management and behavior health tools. The program extends beyond what traditional, standalone pharmacy benefit organizations can tackle by targeting five key factors contributing to the current epidemic, including:

  • Prevention and education: Promoting appropriate use of opioid drugs through education of patients, providers, caregivers/family members and pharmacies regarding risks, proper dosing and duration, storage, safer treatment alternatives and proper disposal.
  • Minimizing early exposure: Aggressively limiting opioid dose and duration of therapy at initial/first fill in alignment with updated CDC prescribing guidelines and generating prompt first-fill member education.
  • Reducing inappropriate supply: Applying evidence-based utilization management protocols after first fill to reduce excessive dosing, limit unnecessary extension of therapy duration, mitigate abuse and diversion, and decrease exposure to harmful drug combinations through real-time medication checks at the point of sale.
  • Treating plan participants who are at risk and high risk: Preventing progression to chronic use, abuse and dependence, and decreasing opportunities for fraudulent prescribing and dispensing through sophisticated analytics modeling, enhanced physician prescribing monitoring, pharmacy dispensing surveillance and auditing, and intensive case management for plan participants who are at high risk.
  • Supporting chronic populations and recovery: Identifying and guiding patients with current or previous overdose, dependence and/or confirmed opioid use disorder through the promotion of evidence-based best practice treatment guidelines, advanced patient monitoring, support and relapse prevention.

"Recognizing this is an issue that can affect any segment of our population at any point in time, successful opioid management programs must tailor engagement based on the needs of an individual," said Calabrese.  "The right level of prevention and care must be delivered, at the right time, to the right stakeholder – using multiple channels and touchpoints – before a member even receives a first opioid prescription through to the effective support and management of those well entrenched in battles to fight this devastating epidemic."

For more information on OptumRx's Opioid Risk Management program, visit

About OptumRx

OptumRx is a pharmacy care services company helping clients and more than 65 million members achieve better health outcomes and lower overall costs through innovative prescription drug benefit services, including network claims processing, clinical programs, formulary management and specialty pharmacy care. Through expertise, flexible technology and a network of over 67,000 community pharmacies and state-of-the-art home delivery pharmacies, OptumRx is putting patients at the center of the pharmacy experience and making health care more connected and less fragmented — ensuring patients get the right medication at the right time at the best cost. OptumRx is part of Optum®, a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. For more information, visit

About Optum

Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 100,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE:UNH). For more information, visit