Decreased Drug Spending in 2016

Workers’ compensation costs have steadily increased for years.  This is due in part to insurance premiums being on the rise for businesses.  Many factors contribute to the rise in premium prices, including the cost of medical services and prescription drugs.  The vast majority of workers’ compensation cases will involve some type of prescription drug treatment for the employee who has suffered a work-related injury. 

Opioid abuse is a widespread problem, with efforts being made across law enforcement agencies and the medical community to reduce the issue as much as possible.  Workers’ compensation systems have also started to recognize the problem and take important steps.  However, opioids are also some of the most expensive prescriptions with thirteen of the top twenty-five most expensive medications being types of opioids.  Although opioids can be an essential step in helping with pain management for an employee who has suffered a work-related injury, the CDC reports that the drugs are also highly addictive.  Some red flags for steps that could put a worker at heightened risk for opioid abuse are prescriptions that last longer than ten days or a second prescription, especially if written after thirty days.

One company has adopted strategies to address the opioid crisis including morphine equivalency doses.  They relate that payers who adopted the program saw a reduction of almost 25%.  The system involves point of sale review as well as drug utilization review to identify the use of long-acting opioids or therapy duplication.  This has also been combined with a notification system that provides notice to the payer if opioids fill exceeding certain thresholds.  Patient education as well as a program to discuss prescribing patterns with medical professionals to help reduce dangerous drug combinations.  Prescribers should be encouraged to prescribe the lowest dose for the shortest duration, optimally fewer than three days.  Prescribers should also be made aware of coordinating efforts with law enforcement and providers where necessary to help with addiction and fraud.  Using these techniques, there was a decrease in opioid spending of 13.4% and an overall decrease in drug spending of 7.6% in 2016.

Physician dispensed medication could be a source of increasing cost in the future as well.  When physicians dispense medication directly to the patient, there is no oversight at the pharmacy, which puts the injured worker at much higher risk of potential drug interaction.  This is especially true when a worker is seeing more than one doctor.  Drug interactions or addiction will keep the employee out of work longer and could have costly implications for him or her for the rest of his or her life.  Drugs delivered directly to a worker’s home, however, could save money by reducing costly channels such as those sometimes found at a retail pharmacy.

If you have questions about the workers’ compensation system and how your business should work to help reduce costs, you need to talk to an experienced attorney.  Call us today at (714) 516-8188 for an appointment to talk about your business.

Opioids and Workers’ Compensation

Opioids are a class of medication that is commonly prescribed to treat pain. It is no secret that the rise of opioid addiction and abuse is a severe problem in the United States. In 2016, it was reported that drug overdose was the leading cause of accidental death in the United States, with opioid abuse being the leading type of drug, and prescription opioids almost double that of heroin. With such a national crisis, the balance in opioid use and workers’ compensation claims is a delicate one.

Musculoskelatal injuries are quite common in work-related injuries, with a typical treatment course being plenty of rest coupled with a type of pain killer. Sometimes these injuries heal completely, but all too often, a worker may be left with a chronic pain condition. A chronic condition is one that lasts more than three months, or lasts after the tissue has finished healing. Long-term opioid use can result in addiction, and in May 2016, it became mandatory for drug manufacturers to include a warning with opioid prescriptions that these drugs carry a high risk of dependency. The CDC has also cautioned doctors against over-prescribing this type of drug.

Between 2012 and 2014, the rate of prescription of opioids in workers’ compensation decreased across 25 states, including California. This is mainly due to a set of new regulations and programs that were adopted with an aim to reduce opioid abuse. The new regulations resulted in a “noticeable decrease” in these states, with some states experiencing a drop between 20 and 31%. Another study indicated that the cost of opioid prescriptions to workers’ compensation claims during this time was decreasing at a rate of $450 per year.

To continue this trend, it may be best for employers to develop a culture of early intervention for certain types of repetitive or stress induced injuries. This would allow workers to report these injuries at a stage at which they can be addressed with rest or physical therapy instead of the prescribing of opioids.

New drugs are also being developed in response to the opioid abuse epidemic. Although still in the development stages, there are many targeted and specialized drugs that may help further reduce the prescription rate of opioids. The impact of the high cost of specialized or compounded drugs on the workers’ compensation system is yet to be seen.

If you have questions about your business and workers’ compensation, contact me today at (714) 516-8188. I am highly experienced in guiding my clients through this complicated area of law.

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