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California State Fund’s great work on opioids

70 doctors are writing one-third of the scripts for opioids in California.

Most of those scripts are for conditions where opioids are NOT appropriate treatment.

Those claimants that get opioids are off work 3.6 times longer; litigation is 60 percent higher, and their claim costs are twice as high as claimants who don’t receive opioids.

Hopefully you’re not so jaded by the flood of bad news about opioids that you yawn and move on to updating your facebook status; given the ongoing flood of bad news about opioids that wouldn’t be surprising.  Most fortunately, California’s state workers comp fund (SCIF), is on this issue like white on rice.

Here’s some of what SCIF is doing:

Kudos to SCIF for their assertive stance; it is great to see a payer take this on with a comprehensive and well-designed approach.
What does this mean for you?
If SCIF can do it, so can you.  And yes, the CA rules may be different, but there are ALWAYS things payers can do to address opioid overuse.



5 thoughts on “California State Fund’s great work on opioids”

  1. Who are these physicians?
    Do you have the list of their names?
    If you have their names, can you publish them?

    1. Betty – sorry, I don’t have the list of names. Some may well be pain management specialists, in which case their prescribing may indeed be consistent with guidelines. However, my guess is many are not.

      1. Betty,
        If you utilize a PBM for the pharmacy portion of your workers’ compensation program you may be able to get a listing of the top prescribing physicians in a particular state.

        Our WC program utilizes PMSI and I can run several reports off of our data that allows me to see top prescribers, top drugs by volume and cost, and top claims – by a state or for our entire program.
        Most WC PBMs should be able to provide this information for you.

        Like Joe says, it may not indicate inappropriate prescribing – you will need to take a deeper dive into the claim particulars to determine whether care is appropriate or not.

    2. Betty,
      In the event that you are not using a carve out PBM it is likely your insurance company or TPA is. They should be able to provide you the same or similar data as that described above.

  2. Similar to the Sports Steroids phenomenon – The drug manufacturers are playing to the lowest common denominator to increase sales, very often to the serious detriment of the patients..And to the detriment of the employers!

    The vise grip held by the AMA is slowly dissipating. The public needs to stand up to the Allopathic Medical Model while accepting personal responsibility for our individual healthcare.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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