Advanced Opioid Management

Advanced Opioid Management®

Advanced Opioid Management, a solution from Express Scripts^® by Evernorth, is a clinically sound approach focused on driving change in our nation’s opioid misuse crisis.

Impact of the opioid crisis

Lost work, health care costs, and lost productivity as a result of drug abuse cost plans an estimated $81 billion per year.¹

The four major dimensions that support a life in recovery include health, home, purpose and community are all being disrupted in today’s complex environment.² And, sadly, there is still a stigma and internal shame associated with addiction and drug misuse. 90% of people who need substance-use disorder treatment don’t get it.³

Focusing on Abuse Prevention and Opioid Recovery

Advanced Opioid Management—a nationally recognized solution—maximizes safety across the care continuum, helping shield clients and their members by minimizing early opioid and opioid adjacent therapy exposure, as well as encouraging treatment and recovery for those patients already suffering from opioid use disorder.

This solution takes a uniquely comprehensive and proactive approach—managing new and acute users; short-term or intermittent users; chronic users; and individuals who are misusing/abusing. We address potential behavior and safety gaps at each touch point:

At the doctor’s office

At the pharmacy

With the patient

Physician discussing with patient health prevention and recovery

Aligns with CDC Guidelines

As a clinically-driven solution, Advanced Opioid Management has been designed to align with the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain, which provides guidance to primary care clinicians prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Meaningful impact and influence across the care continuum

Alerts sent when patient activity indicates potential abuse

Prescriber education and peer comparison

Alerts sent suggesting proactive naloxone therapy, where appropriate

Enhanced Fraud, Waste & Abuse lock-in, where appropriate

Alerts sent when opioids are prescribed to patients with mental health or prenatal vitamin prescriptions

Alerts sent when members are demonstrating poor adherence to Medication Assisted Treatment

Informational letter detailing the risks of opioid use

Proactive Express Scripts Neuroscience Therapeutic Research Center^® pharmacist outreach, including Medication Assisted Treatment support

Supply of drug disposal bags, when needed, reducing the chance for excessive use or diversion

Case management support for members whose prescription history triggered an intervention that locked them into a single provider or pharmacy to help prevent fraud, waste, and abuse

Mental health, suicide and additional hotline information delivered to patients

New for 2024: addition of over-the-counter NARCAN® Nasal Spray to the program

Supply limits for adults¹ and children² initiating opioid therapy for each of their first 4 fills

Prior authorization required for members starting opioids who accumulate > 90 morphine milligram equivalents (MME)

Prior authorization required for members who accumulate > 200MME

Prior authorization on first fill of a long-acting opioid to encourage a safe start

Safer fentanyl utilization initiatives

Opioid adjacent therapy quantity limits