Use of Opioids from Multiple Providers (UOP)

Date: 07/21/23

What is the UOP Measure Looking At?

The percentage of members 18 years and older, receiving prescription opioids for greater than or equal to 15 days during the measurement year from multiple providers. Three rates are reported.

1. Multiple Prescribers: The proportion of members receiving prescriptions for opioids from four or more different prescribers during the measurement year.
2. Multiple Pharmacies: The proportion of members receiving prescriptions for opioids from four or more different pharmacies during the measurement year.
3. Multiple Prescribers and Multiple Pharmacies: The proportion of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year.

What is the Intent of the Measure?

To assess for potentially high-risk opioid analgesic prescribing practices and identify members at risk for opioid overuse and misuse. A lower rate (less members numerator compliant) indicates better performance.

Who is Included?

• Medicare and Medicaid members 18 years and older as of January 1 of the measurement year
• Prescribed at least two or more opioid dispensing events on different dates of service
• ≥15 total days covered by opioids

What are the Opioid Medications? 

• Benzhydrocodone          
• Buprenorphine (transdermal patch and buccal film)         
• Butorphanol      
• Codeine              
• Dihydrocodeine
• Fentanyl             
• Hydrocodone   
• Hydromorphone             
• Levorphanol      
• Meperidine
• Methadone
• Morphine
• Opium
• Oxycodone
• Oxymorphone
• Pentazocine
• Tapentadol
• Tramadol

What is Excluded?

• Members in hospice or expired anytime during the measurement year
• These following medications are excluded from the measure:
  • Injectables
  • Opioid-containing cough and cold products
  • Single-agent and combination buprenorphine products of medication-assisted treatment of opioid use disorder
  • Ionsys® (fentanyl transdermal patch).
  • Methadone for the treatment of opioid use disorder

What Can You Do to Help?

• Reference the CDC Guideline for Prescribing Opioids for Chronic Pain.
• Review the Prescription Drug Monitoring Program (PDMP) registry for your state regularly.
  • PDMD data should be reviewed prior to initiating opioid therapy and periodically, ranging from every prescription to every 3 months.
• Only prescribe opioids when medically necessary, in the lowest effective dose, for the shortest duration necessary.
• Identify alternatives to opioids for pain management such as NSAIDs, physical therapy, acupuncture, massage therapy, and corticosteroids when clinically appropriate.
• Set patient-prescriber expectations early-on regarding controlled-substance prescriptions from other providers and the use of multiple pharmacies.
• Coordinate care and communication between the physical and behavioral health providers, including transitions in care.
• Educate patient on opioid safety and risk associated with use of multiple opioids from different providers. 

Additional Support:

• National Committee for Quality Assurance
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Center for Disease Control and Prevention

 

Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who your representative is, please email us at WI_Provider_Relations@mhswi.com.