United Healthcare cites success in limit on opioid dental prescriptions for ages 19 or under

Originally Published by Crain’s Detroit Business

• United Healthcare’s three-day opioid dental prescription policy for those age 19 or under has contributed to 17 percent drop in all-age prescriptions.
• United also is targeting the top 20 percent of dental opioid prescribers for additional education and 10 U.S. cities that have high overdose mortality rates for public education.
• Dentists and oral surgeons write 12 percent of all opioid prescriptions

United Healthcare’s four-month old policy that limits first-time opioid prescriptions for dental patients age 19 or under to three days as recommended by the U.S. Centers for Disease Control and Prevention has been a success, said Ted Wong, its chief dental officer.

As one of the first dental plans in the U.S. to impose a three-day restriction on adolescents, United Healthcare (NYSE: UNH) implemented the policy Oct. 1 in an effort to save lives and reduce unnecessary opioid use. The restriction also limits dosages to fewer than 50 morphine milligram equivalents per day.

Along with a dental professional education program, Wong said dentists and oral surgeons have reduced opioid prescriptions by 17 percent for all ages of patients.

Wong said the Minnetonka, Minn.-based company analyzed claims and found that dentists and oral surgeons write 12 percent of all opioid prescriptions, including 45 percent of prescriptions for children and adolescents under age 19.

“This is the age where children have their wisdom teeth extracted,” said Wong, noting that more than two-thirds of wisdom teeth extractions for people ages 16 to 22 result in at least one opioid prescription. he said.

A recent study from Stanford University found that teens and young adults can end up in a battle with opioid addiction following wisdom teeth removal.

Wong said United Healthcare is promoting its new opioid policy as part of February’s Children’s Dental Health Month.

More than 2 million people are diagnosed with opioid addictions and 130 people die each day, Wong said. Reducing the volume of opioids prescribed also can address the fact that more than 50 percent of opioid pills from dental prescriptions go unused

“We want to reduce the amount of opioids on the street,” he said. “We know there is room for improvement.”

The economic cost from the opioid epidemic exceeds $500 billion annually, according to a study from The Council of Economic Advisors.

Before the three-day policy for opioids for age 19 or under, Wong said United Healthcare’s policy was a seven-day limit, which remains in effect for adults.

“We have seen a 90 percent reduction in (prescriptions) that exceeded the CDC guidelines,” he said. “Some prescriptions still exceed the requirements. We have a prior authorization and a waiver policy for (dental providers) who feel their patients require more days.”

But Wong said there are few patients who need opoids for more than three days. The company also is suggesting dentists prescribe Tylenol or Motrin as substitutes in some cases.

“We did not want to limit access for people needing acute care management,” he said. “If you go beyond three days, another pain pill won’t do any good. You should go see your dentist to” determine if there is another problem with the extraction or pain.

Wong said United Healthcare hasn’t looked at cost savings the company might experience with the reduced amount of opioid prescriptions. “The focus here is to reduce the amount of opioids in dental providers” and ultimately patients, he said.

United Healthcare also plans to expand its public and dental provider education program.

For example, in 10 cities across the United States that are greatly affected by the opioid epidemic, United Healthcare has launched the Opioid Community Partnership to drive local initiatives designed to make rapid, measurable gains in the fight against opioid misuse. The cities were chosen in part where there has been shown high rates of opioid misuse and deaths from drug overdoses.

The 10 cities are Dayton, Dallas, New Orleans, Palm Beach, Fla., Las Vegas, Phoenix, Little Rock, Ark., Nashville, York, Penn., and Winston-Salem, N.C.

UHC’s opioid dental education program also includes:

• Working closely with dental health professionals who have been identified as among the top 10 percent of highest opioid prescribers in United Healthcare’s network to receive information on their prescribing habits. The company measures this by the number of days per supply or dosages measured by morphine milligram equivalents per day. It has now expanded this to the top 20 percent of prescribers who exceed the CDC recommendations
• Dental plan members who have dependents ages 16 to 22 will receive information by mail about the risks associated with opioids, especially in connection to wisdom teeth extractions.