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Optima Health Decreases Prescription Opioids By 49 Percent For Medicaid Members

VIRGINIA BEACH, Va., March 28, 2019 /PRNewswire/ -- Virginia-based Optima Health unveiled remarkable new data on prescription opioid reductions among Medicaid members. Anyone can suffer from opioid dependence, addiction, and deadly overdose, even when prescribed the opioid by their doctor. That's why Optima Health has focused on fewer prescriptions and lower doses, in a unique collaboration with the other Medicaid health plans and healthcare organizations throughout the state. According to data from Optima Health, results include:

  • 30 percent fewer members with a prescription for an opioid
  • 43 percent reduction in prescriptions
  • 49 percent reduction in total quantity of prescription opioid tablets and caplets
  • 2.5 million fewer pills prescribed (2,525,085 to be exact)

Theresa Carpenter, a clinical pharmacist with Optima Health, explained, "The opioid utilization management program is working to change how healthcare providers treat pain. A major concept in our work is changing the mindset from prescribing opioids as the first line for pain management for all patients."

Optima Health was part of a partnership led by the Virginia Department of Medical Assistance Services, which included Virginia Department of Health, Department of Health Professions, Medical Society of Virginia, and the other five Medicaid health plans in Virginia to implement uniform policies that align with the U.S. Centers for Disease Control and Prevention (CDC) Guidelines and Virginia Board of Medicine Regulations.

The collaboration – including all six Medicaid plans in Virginia – was essential to the program's success. As each health plan grappled with the opioid epidemic at the same time, common policies helped healthcare providers establish new procedures and prevented opioid-dependent patients from shopping for the least restrictive plan.

As examples of common policies, Carpenter noted, "We removed barriers to prescribing non-narcotic alternatives to opioids that actually may be more effective in helping people manage their pain. When an opioid is truly called for, we've decreased the quantity of pills allowed in the prescription, added coverage of certain less-risky formulations, and followed the CDC Guideline to provide certain patients with the prescription opioid along with a prescription for naloxone, which is an injection or nasal spray that can reverse an overdose. What's more, we've partnered with physicians throughout the state to change how they write their discharge orders so a patient is much less likely to leave the hospital with an opioid prescription."

Carpenter added a message to Virginians who continue to receive opioid prescriptions from their doctor or other healthcare provider, saying, "If your doctor prescribes an opioid – such as oxycodone, hydrocodone, codeine, morphine, and others – and you have concerns about the long-term impact of this class of drugs, you can discuss with your provider non-narcotic treatments. Fortunately, opioids aren't the only option."

In addition to increased emphasis on decreasing opioid use amongst its members, Optima Health has also committed to increasing access to addiction treatment services. This includes opioid addiction medication, counseling, and psychosocial supports.

The new policies do not apply to Medicaid members with certain types of intractable pain. People with pain associated with active cancer, palliative care (treatment of a life-limiting illness), or hospice care may continue to receive prescription opioids.

According to the CDC, opioids were involved in 47,600 overdose deaths in 2017 (the last year for which data is available), including 1,507 deaths in Virginia. The prescription data of Optima Health is based on October 2017-September 2018, compared to the same period a year earlier.

About Optima Health
Optima Health, based in Virginia, provides health insurance coverage to more than 510,000 members. With more than 30 years of experience, Optima Health offers a suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Its provider network features 26,000 providers including specialists, primary care physicians and hospitals across Virginia. Optima Health also offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services, as well as pharmacy management—all to help members improve their health every day. The company's goals are to provide better health, be easy to use and offer services that are a great value. Optima Health is a service of Sentara Healthcare. To learn more about Optima Health, visit


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Last Updated: 28-Mar-2019