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Latest featured insights

Article

Much more than pharmacy benefits

With our whole-person approach to injured person care, we can lower costs and support an injured individual’s interconnected needs.

Policy-regulatory update

Policy Matters Alert - 2025 - July 1

New York WCB adopts changes to pharmacy direction of care regulations to take effect July 11, 2025.

White paper

Living out our commitment to compassionate service

Optum is focused on providing personalized, compassionate service to all stakeholders. Hear how our customer service professionals embody this commitment every day.

White paper

Caring for workers affected by climate change

Climate change poses significant health risks for workers. Optum programs work together to address an injured worker’s varied and often codependent needs.

 

Clinical services

Clinical update

New migraine medication Symbravo approved by FDA

On January 30, 2025, Axsome Therapeutics announced the U.S. FDA approval of Symbravo for the acute treatment of migrane.

White paper

Caring for workers affected by climate change

Climate change poses significant health risks for workers. Optum programs work together to address an injured worker’s varied and often codependent needs.

White paper

Obesity in the workforce and GLP-1 medications

GLP-1 medications can offer substantial benefits for overweight injured workers. Our clinical and policy experts can help you navigate the evolving GLP-1 landscape.

Article

Formulary management as a strategic safeguard

Formulary management works with the authorization process to support worker safety, reduce complexity, and prevent unintended billing errors.

 

Corporate partnership

Article

Much more than pharmacy benefits

With our whole-person approach to injured person care, we can lower costs and support an injured individual’s interconnected needs.

Article

What are the must-have qualities for your PBM partner?

When selecting a business partner, it is important to prioritize the qualities and values you know are critical to a successful relationship.

White paper

A CEO discusses turning challenges into opportunities

Market changes and evolving client needs can create challenges. By tuning in to these needs and thinking strategically, challenges can become opportunities.

Article

Optum and ProCare collaborate to deliver a better client experience

The Optum and ProCare CEOs explain the strategy behind their organizations’ collaboration and how it will benefit the client experience.

 

Cost containment

White paper

Partnership and strategies to improve your bill review savings

The Optum Clinical & Coding Logic works in conjunction with standard and proprietary bill review platforms to uncover additional opportunities for savings.

Article

Factors to consider when evaluating PBM pricing models

PBM pricing methodologies and models can be tricky to compare. A better understanding of their similarities and differences can help.

Article

Questions to ask when comparing PBM pricing models

Multiple factors affect PBM pricing. By asking the right questions, payers can find the right fit and the most savings for their organization.

Article

How PBM cost savings help auto insurers attract policyholders

Auto insurers face financial challenges from increasingly frequent and severe claims. With a sound strategy, carriers can stay profitable.

 

Policy/regulatory guidance

Policy-regulatory update

Policy Matters Brief - 2025 - July 9

Recent state policy updates in CA, MN, NV, OR, RI, WA, and WI.

Policy-regulatory update

Policy Matters Alert - 2025 - July 8

New York WCB issues updates to pharmacy direction of care rules for certain medically necessary circumstances.

Policy-regulatory update

Policy Matters Alert - 2025 - July 1

New York WCB adopts changes to pharmacy direction of care regulations to take effect July 11, 2025.

Policy-regulatory update

Policy Matters Alert - 2025 - June 13

On July 1, 2025, California DWC will roll-out a new pharmacy fee schedule for Medi-Cal pharmacy rates.

 

Program features

White paper

Living out our commitment to compassionate service

Optum is focused on providing personalized, compassionate service to all stakeholders. Hear how our customer service professionals embody this commitment every day.

White paper

Surgery Plan feature saves precious time for adjusters

The Surgery Plan feature of our pharmacy portal lightens the workload for adjusters with claimants preparing for surgery.

Article

AI models and human expertise combine to predict claim risk

Optum uses AI to predict risk and likely outcomes for injured persons. Yet even with technological advances, human claim oversight is critical.

Article

Using AI predictions to drive improved recovery scenarios

AI-driven risk identification allows our clinicians to address potential treatment needs more quickly and drive a better therapeutic outcome.

 

Program management

Article

5 med management trends to watch in workers' comp

Our annual review of drug utilization data revealed key industry trends and policy developments shaping workers’ compensation care in 2025 and beyond.

Article

Using the Topicals Toolbox to address topicals prescribing

When a topical medication is deemed medically necessary, it helps to have resources that provide insight into utilization and overall cost.

Article

Why client experience is essential in workers’ comp

A commitment to fostering an excellent client experience can help workers’ comp service providers stand out from the crowd.

White paper

Understanding traditional and transparent pricing models

Optum offers both traditional (discount to AWP) and transparent (cost-plus) pricing. Learn more about each model and what might work best for your organization.

 

All insights

Why varied expertise is key to successful PBM clinical programs

When the PBM team includes clinicians with a wide array of clinical experience and expertise, injured persons get the best care possible.

Much more than pharmacy benefits

With our whole-person approach to injured person care, we can lower costs and support an injured individual’s interconnected needs.

Benefits of partnering with a pharmacy benefit manager

While helping to reduce pharmaceutical costs, a good PBM partner can also improve therapeutic outcomes and reduce recovery time.

A new CEO sees bright opportunities in technology and talent

Matt Wolfe, CEO, joined the Optum Workers’ Comp and Auto No-Fault team in July 2024 and sees the groundwork laid for a great path ahead.

How Optum helps payers stay on top of PTSD legislation

When it comes to PTSD laws covering workers’ comp, no two states are the same. The Optum PPRA team helps clients stay informed and compliant.

Why client experience is essential in workers’ comp

A commitment to fostering an excellent client experience can help workers’ comp service providers stand out from the crowd.

Factors to consider when evaluating PBM pricing models

PBM pricing methodologies and models can be tricky to compare. A better understanding of their similarities and differences can help.

How PBM cost savings help auto insurers attract policyholders

Auto insurers face financial challenges from increasingly frequent and severe claims. With a sound strategy, carriers can stay profitable.

5 med management trends to watch in workers' comp

Our annual review of drug utilization data revealed key industry trends and policy developments shaping workers’ compensation care in 2025 and beyond.

Using AI predictions to drive improved recovery scenarios

AI-driven risk identification allows our clinicians to address potential treatment needs more quickly and drive a better therapeutic outcome.

AI models and human expertise combine to predict claim risk

Optum uses AI to predict risk and likely outcomes for injured persons. Yet even with technological advances, human claim oversight is critical.

Questions to ask when comparing PBM pricing models

Multiple factors affect PBM pricing. By asking the right questions, payers can find the right fit and the most savings for their organization.

A leader explains his lifetime mission to improve and simplify

Matt Wolfe is committed to transformational improvement. As the new CEO of Optum Workers’ Comp and Auto No-Fault, he continues this mission.

How many meds are too many meds?

Optum clinicians discuss how the right number of medications depends on a person’s unique medical profile, conditions, injuries, and comorbidities.

Personalized care drives better outcomes for injured workers

A focus on just the injury can lead to health issues and higher costs. That’s why Optum emphasizes a holistic, personalized approach to care.

Considerations for auto payers in selecting a PBM partner

Auto payers understand that auto claims are complex, and it’s important that their pharmacy and ancillary program partners understand as well.

Optum and ProCare collaborate to deliver a better client experience

The Optum and ProCare CEOs explain the strategy behind their organizations’ collaboration and how it will benefit the client experience.

What is the health story and why is it so important?

Exploring an injured worker’s health story builds trust and helps pharmacists offer more compassionate and informed care.

What are the must-have qualities for your PBM partner?

When selecting a business partner, it is important to prioritize the qualities and values you know are critical to a successful relationship.

Using the Topicals Toolbox to address topicals prescribing

When a topical medication is deemed medically necessary, it helps to have resources that provide insight into utilization and overall cost.

Formulary management as a strategic safeguard

Formulary management works with the authorization process to support worker safety, reduce complexity, and prevent unintended billing errors.

Caring for workers affected by climate change

Climate change poses significant health risks for workers. Optum programs work together to address an injured worker’s varied and often codependent needs.

Partnering with an established and stable enterprise

A vendor partner with a stable and respected market presence protects your organization and enhances your credibility in the eyes of your customers.

PTSD coverage expands with increased focus on mental health

Coverage for PTSD is a high-profile topic in workers’ compensation. Learn about state legislative efforts to address and expand coverage.

Dispelling rumors about PPOs and other medical networks

Frequently asked questions, and answers, offer definitions and clear information about the purpose and benefits of PPOs and medical networks.

Early awareness of potential risk through the Optum Risk Score

The Optum proprietary and visual Risk Score alerts claims professionals to high-risk claims early, before spend and severity increase.

Understanding traditional and transparent pricing models

Optum offers both traditional (discount to AWP) and transparent (cost-plus) pricing. Learn more about each model and what might work best for your organization.

Living out our commitment to compassionate service

Optum is focused on providing personalized, compassionate service to all stakeholders. Hear how our customer service professionals embody this commitment every day.

Partnership and strategies to improve your bill review savings

The Optum Clinical & Coding Logic works in conjunction with standard and proprietary bill review platforms to uncover additional opportunities for savings.

Supporting behavioral health in injury recovery

For injured persons, the road to recovery can sometimes look dark. Support for behavioral health can ease burdens and light the path forward.

Top 10 factors in the successful management of high-risk claims

By managing needed care efficiently, the insurer and claims team can improve quality of life for the injured person and support overall recovery prospects.

Obesity in the workforce and GLP-1 medications

GLP-1 medications can offer substantial benefits for overweight injured workers. Our clinical and policy experts can help you navigate the evolving GLP-1 landscape.

A CEO discusses turning challenges into opportunities

Market changes and evolving client needs can create challenges. By tuning in to these needs and thinking strategically, challenges can become opportunities.

Embracing strategies for improved nutrition

Injuries and related challenges can create barriers to good nutrition. But proven, science-based nutritional strategies can help with recovery.

A career defined by a commitment to clients

The new Senior VP of Client Experience explains how the Optum commitment to a positive client experience echoes her professional philosophy.

Benefits of proactive adjuster involvement in auto claims

Regulations may discourage auto adjusters from engagement in the adjudication process. But active involvement can deliver significant benefits.

Surgery Plan feature saves precious time for adjusters

The Surgery Plan feature of our pharmacy portal lightens the workload for adjusters with claimants preparing for surgery.

A closer look at the effects of comorbidities

An explanation of five ways that comorbid conditions can increase complications, lengthen recoveries, and lead to higher costs.

New migraine medication Zavzpret approved by FDA

On March 10, 2023, the U.S. FDA approved Zavzpret™ (zavegepant) nasal spray, indicated for the acute treatment of migraine in adults.

New nasal spray medication Opvee approved by FDA

Opvee® (nalmefene) 2.7 mg nalmefene nasal spray has been approved by the U.S. FDA and is available for emergency treatment of opioid overdoses.

Optum Brand-Generic Pipeline Q2 2023

New medications and first-time generics or brand alternatives approved by the U.S. FDA for the treatment of a workers’ comp or auto injury.

Teva initiates voluntary nationwide recall of fentanyl buccal tablets

Teva Pharmaceuticals USA has voluntarily recalled specific lots of various strengths of fentanyl buccal tablets due to a labeling error.

Brand name Duexis and generic alternatives no longer manufactured

The U.S. FDA has announced that Duexis® and generic famotidine, indicated to treat pain and inflammation, will no longer be manufactured.

Optum Brand-Generic Pipeline Q1 2023

New medications and first-time generics or brand alternatives approved by the U.S. FDA for the treatment of a workers’ comp or auto injury.

FDA announces safety concern with two antiseizure medications

On November 28, 2023, the U.S. FDA issued a warning that levetiracetam and clobazam can cause a rare but serious adverse reaction.

American Geriatrics Society updates AGS Beers Criteria

The American Geriatrics Society has published an update to the AGS Beers Criteria® for potentially inappropriate medication use in older adults.

Narcan OTC naloxone nasal spray approved by FDA

On July 28, 2023, the U.S. FDA approved Narcan® (naloxone hydrochloride) 4 mg Nasal Spray for OTC non-prescription use.

Updates to ODG Drug Formulary Appendix A

On April 21, 2023, the ODG Drug Formulary (Appendix A) status changed for several topical analgesic and NSAID medications.

Optum will modify three opioid analgesic conversion factors

In January 2024, Optum clinical programs will adopt revised morphine equivalent dose (MED) conversion factors.

Akorn initiates voluntary nationwide recall of several drug products

Akorn Operating Company LLC has voluntarily recalled several drug products at the consumer level due to quality concerns.

New Brixadi buprenorphine treatment approved by FDA

On May 23, 2023, the U.S. FDA approved Brixadi™ (buprenorphine) ER injection for the treatment of moderate to severe opioid use disorder.

Optum Brand-Generic Pipeline Q3 2023

New medications and first-time generics or brand alternatives approved by the U.S. FDA for the treatment of a workers’ comp or auto injury.

RiVive (naloxone) nasal spray approved by FDA

On July 28, 2023, the U.S. FDA approved Harm Reduction Therapeutics RiVive™ (naloxone) nasal spray 3 mg for OTC nonprescription use.

More naloxone options for opioid analgesic overdose

In October 2021, the U.S. FDA approved a higher-dose naloxone hydrochloride (HCl) injection, ZIMHI™ (5 mg/0.5 mL), for opioid analgesic overdose.

New insomnia treatment Quviviq approved by FDA

On January 10, 2022, the U.S. FDA approved Quviviq™ (daridorexant) 25 mg and 50 mg tablets for the treatment of adults with insomnia.

DEA National Prescription Drug Take Back Day is October 29, 2022

Check for unneeded medications at home and make a plan to drop them off on DEA National Prescription Drug Take Back Day.

FDA issues warning for certain Buprenorphine medications

On January 12, 2022, the U.S. FDA issued a warning regarding potential risk of dental problems with orally-dissolving buprenorphine medications.

Gastrointestinal medication Zelnorm withdrawn from the market

Effective June 30, 2022, Zelnorm® 6 mg tablet, indicated for treatment of IBS-C in adult women, will no longer be produced and marketed in the U.S.

FDA warning regarding topical pain relief preparations

On March 26, 2024, the U.S. FDA issued a warning for consumers to avoid certain over-the-counter (OTC) analgesic products.

Recall of Duloxetine capsules

On May 4, 2024, the U.S. FDA reported that Breckenridge Pharmaceutical, Inc. issued a retail level recall of duloxetine delayed-release capsules.

One lot of tizanidine 4 mg tablets voluntarily recalled

On January 12, 2024, the U.S. FDA reported that Dr. Reddy’s Laboratories Inc. issued a voluntary recall of tizanidine 4 mg tablets.

New migraine medication Symbravo approved by FDA

On January 30, 2025, Axsome Therapeutics announced the U.S. FDA approval of Symbravo for the acute treatment of migrane.

New pain medication Journavx approved by FDA

On January 30, 2025, the U.S. FDA approved Journavx™ (suzetrigine) for the treatment of moderate-to-severe acute pain in adults.

Policy Matters Alert - 2025 - February 4

New York WCB notifies providers they must contract with an electronic trading partner for submission of CMS-1500 billing forms.

Policy Matters Alert - 2025 - July 8

New York WCB issues updates to pharmacy direction of care rules for certain medically necessary circumstances.

Policy Matters Brief - 2024 - June 12

Recent state policy updates in CA, FL, KY, MT, NY, NJ, OK, and WA.

Policy Matters Brief - 2024 - February 28

Recent state policy updates in CA, HI, KY, NM, NY, and WI, as well as the introduction of several workers’ comp firefighter coverage and presumption bills.

Policy Matters Brief - 2024 - August 22

Recent state policy updates in CA, DE, FL, ID, and TX, as well as notice of readoption of the NCOIL Model Workers’ Compensation Drug Formulary Act.

Policy Matters Brief - 2024 - May 1

Recent state policy updates in AL, CA, KY, LA, PA, TX, and WI.

Policy Matters Brief - 2024 - October 30

Recent state policy updates in CA, FL, MA, MN, and NM.

Policy Matters Brief - 2024 - April 10

Recent state policy updates in AL, GA, KS, LA, MD, MN, OH, OK, SC, TX, VA, WV, and WY, as well as more information about PTSD legislation.

Policy Matters Brief - 2024 - July 31

Recent state policy updates in AK, CO, FL, KY, ID, MI, MN, OH, PA, and TX.

Policy Matters Brief - 2024 - February 7

Recent state policy updates in AZ, CA, CO, IN, NJ, OH, OK, TN, VA, and WI.

Policy Matters Alert - 2024 - March 4

California proposes rule changes while integrating its workers’ comp pharmacy reimbursement process into the state’s Medicaid pharmacy reimbursement structure.

Policy Matters Brief - 2024 - December 11

Recent state policy updates in CO, NM, NV, NY, OH, TX, VT, and WA.

Policy Matters Brief - 2024 - July 10

Recent state policy updates in CA, FL, ID, MI, MT, NY, and RI, as well as notice of the annual SAWCA convention.

Policy Matters Brief - 2024 - November 20

Recent state policy updates in AK, CA, NY, and WA.

Policy Matters Alert - 2024 - May 16

Details around a recent AP report that the U.S. DEA has agreed to move forward with a process to reclassify marijuana under federal law.

Policy Matters Brief - 2024 - January 17

Fee schedules adopted in AK, IL, MA, ME, NE, OH, OR, PA, RI, UT, and WA. Policy activity in CA, NY, NM, PA, TN, and VA, as well as PTSD and mental health bills.

Policy Matters Brief - 2024 - October 14

Recent state policy updates in CA, CO, MN, NM, and PA.

Policy Matters Alert - 2024 - June 27

New York lawmakers pass legislation impacting the ability of employers and insurers to direct workers’ comp pharmacy care.

Policy Matters Brief - 2024 - September 12

Recent state policy updates in CA, NM, NY, OH, PA, and TX.

Policy Matters Alert - 2024 - June 20

As California moves forward with modifications to its proposed workers’ comp pharmacy fee schedule, Optum remains engaged and keeps clients informed.

Policy Matters Brief - 2024 - March 20

Recent state policy updates in AL, CA, FL, KY, MD, MI, MT, OK, OR, and TX, as well as updates on pending PTSD coverage bills and notice of the 2024 IAIABC Forum.

Policy Matters Brief - 2024 - May 22

Recent state policy updates in AK, CO, ID, MT, OK, and VA, as well as NCOIL updates to model law on drug pricing transparency.

Policy Matters Brief - 2023 - December 6

Recent state policy updates in AK, CA, MD, and OR.

Policy Matters Brief - 2023 - August 16

Recent state policy updates in CA, MI, OH, OK, and WA, as well as notice of the first annual VA workers’ comp medical fee schedule symposium.

Policy Matters Brief - 2023 - June 15

Recent state policy updates in AZ, CA, CO, FL, OR, MI, TN, and VA.

Policy Matters Brief - 2023 - October 25

Recent state policy updates in CA, FL, MA, MI, OR, TN, as well as notice of the SAWCA 2023 All-Committee Conference.

Policy Matters Brief - 2023 - July 26

Recent state policy updates in NJ, NY, and TN, as well as notice of the SAWCA Annual Convention.

Policy Matters Brief - 2023 - March 1

Recent state policy updates in CA, CO, CT, NJ, NY, and ND.

Policy Matters Brief - 2023 - February 8

Recent state policy updates in FL, IL, KY, LA, OH, OR, SC, and WV.

Policy Matters Brief - 2023 - April 14

Recent state policy updates in FL, KY, OR, SC, UT, and VA, as well as notice of the AAPAN Innovations Retreat and IAIABC Forum.

Policy Matters Brief - 2023 - May 4

Recent state policy updates in MI, MT, WA, as well as WCRI updates to workers’ comp pharmacy regulations.

Policy Matters Brief - 2023 – September 13

Recent state policy updates in CA, ME, MI, MS, and WA, as well as notice of the IAIBC Convention.

Policy Matters Brief - 2023 - March 22

Recent state policy updates in AL, CA, MN, MT, and NY, as well as Physician choice legislation intoduced in Montana and Iowa.

Policy Matters Brief - 2023 - July 5

Recent state policy updates in AZ, CO, CT, MN, MT, NJ, and NY, as well as notice of the SAWCA Annual Convention.

Policy Matters Brief - 2023 - November 15

Recent state policy updates in MA, ME, MI, NJ, NM, NY, OH, VA, and WA.

Policy Matters Brief - 2023 - May 24

Recent state policy updates in CT, IL, MI, MT, TN, and WA.

Policy Matters Brief - 2023 - January 19

Recent state policy updates in CA, FL, IN, MN, NM, and NY, as well as the Federal Firefighters Fairness Act and HHS proposed standards for health care attachments.

Policy Matters Brief - 2023 - October 4

Recent state policy updates in AZ, CA, CO, NY, TN, and VA.

Policy Matters Brief - 2022 - July 27

Recent state policy updates in CO, CT, FL, IA, KY, LA, MT, NJ, NY, and TN.

Policy Matters Brief - 2022 - March 30

Recent state policy updates in GA, KS, KY, LA, and MI.

Policy Matters Brief - 2022 - December 7

Recent state policy updates in KY as well as proposed updates to HIPAA pharmacy billing standards.

Policy Matters Brief - 2022 - October 5

Recent state policy updates in CA, CO, MI, and NY.

Policy Matters Brief - 2022 - May 11

Recent state policy updates in KY, IL, NY, TN, VA, and WI.

Policy Matters Brief - 2022 - June 22

Recent state policy updates in CA, MN, NY, OK, and TX, as well as notice of the SAWCA annual convention.

Policy Matters Brief - 2022 - August 17

Recent state policy updates in AK, CA, CO, NY, and OR.

Policy Matters Brief - 2022 - March 9

Recent state policy updates in NY, MN, OR, and UT.

Policy Matters Brief - 2022 - February 16

Recent state policy updates in CA, CO, KY, MI, MS, NJ, and OK.

Policy Matters Brief - 2022 - February 3

Implementation schedule for New York Workers’ Compensation Board OnBoard Drug Formulary and DMEPOS fee schedule.

Policy Matters Brief - 2022 - November 16

Recent state policy updates in CA, MS, TN, NJ, and VA, as well as notice of the SAWCA All Committee Conference.

Policy Matters Brief - 2022 - October 26

Recent state policy updates in CA, FL, MI, and NY.

Policy Matters Brief - 2022 - January 19

Recent state policy updates in CA, NC, and VA.

Policy Matters Brief - 2022 - April 20

Recent state policy updates in CT, IN, NJ, NY, UT, and WA.

Policy Matters Brief - 2022 - September 7

Recent state policy updates in CA, TX, KY, OH, as well as notice of the IAIABC Convention.

Policy Matters Brief - 2022 - June 1

Recent state policy updates in CA, MT, and OK.

Policy Matters Brief - 2025 - January 16

Recent state policy updates in AL, CA, ME, NC, NY, OH, TX, and WA.

Policy Matters Brief - 2025 - March 20

Recent state policy updates in AK, CO, ID, NJ, NY, OR, and VA.

Policy Matters Alert - 2025 - June 13

On July 1, 2025, California DWC will roll-out a new pharmacy fee schedule for Medi-Cal pharmacy rates.

Policy Matters Brief - 2025 - May 8

Recent state policy updates in AL, CA, IN, MT, NM, NY, OH, TN, and WV.

Policy Matters Alert - 2025 - July 1

New York WCB adopts changes to pharmacy direction of care regulations to take effect July 11, 2025.

Policy Matters Brief - 2025 - April 15

Recent state policy updates in AK, CO, ID, KY, MD, NM, OH, SD, and UT.

Policy Matters Brief - 2025 - May 21

New York WCB offers education on CMS-1500 project prior to 8/1/25 ebilling mandate.

Policy Matters Brief - 2025 - May 28

California Legislative committee passes presumption and Qualified Medical Evaluator bills.

Policy Matters Brief - 2025 - February 27

Recent state policy updates in AL, AZ, CA, MI, OR, and VA.

Policy Matters Alert - 2025 - February 24

California DWC adopts final rules for its workers’ comp fee schedule and proposes policy changes to Utilization Review rules.

Policy Matters Brief - 2025 - February 6

Recent state policy updates in CA, CO, FL, IL, NM, NY, OH, OK, OR, and VA.

Policy Matters Alert - 2025 - April 4

A ruling from the Pennsylvania Supreme Court changes how OTC medications are prescribed and provided to injured workers.

Policy Matters Brief - 2025 - July 9

Recent state policy updates in CA, MN, NV, OR, RI, WA, and WI.

Policy Talk Ep 1 - New Beginnings - 2025 April 10

In a lively and informal format, Optum policy experts provide updates on policy changes in CA and CO; PTSD presumptions; and NY eBilling.