Welcome to the war, everyone.
Okay, so work comp is not the most progressive industry. We are – often justifiably – seen as slow-moving, overly conservative, reluctant to adopt change and averse to innovation.
Except when it comes to opioids, where work comp has been far in front – and continues to lead. By advocating for treatment guidelines, restrictions of physician dispensing of opioids, formularies tied tightly to UR, analytics and clinical intervention, work comp has long been very active in a crisis that is only now getting real attention in the “real world”.
In a shocking statistic, opioid-related deaths in this country hit 28,647 in 2014, a 9% increase over 2013,
On the “What in hell took you so long”, it is wonderful to see the President call for $1.1 billion in funds to address the opioid crisis. The mainstream media is (finally) all over the issue. Congresspeople are strident and passionate, finally joining Rep. Hal Rodgers R KY who has long been a leader, calling for action action action. Presidential candidates are speaking out about the crisis. It is an acknoledged public health emergency. The CDC is promulgating guidelines. Meanwhile, the opioid industry and their supporters are employing all their usual tactics in an effort to keep their profits flowing – expect them to spend whatever they need to.
For those of us in work comp who have been desperately working on the issue for years, this is welcome indeed. We’ve been fighting this battle for at least ten years, thanks to research by CompPharma, CWCI, NCCI, and WCRI. Innovative efforts by a few insurers. Passionate and vocal leadership from pharmacists and medical directors. Washington State fund L&I’s Gary Franklin MD has been the industry’s leading voice on this issue for a decade, and the progress L&I has made under his direction (kudos to Jaymie Mai, PharmD as well) has been enormous.
The American Insurance Association’s Bruce Wood has been a forceful voice for common-sense, practical solutions, tirelessly bringing this issue to the attention of legislators, regulators, comp executives, and other stakeholders
A special shout out to PBMs, where diligent, targeted, persistent effort by execs, case managers, medical directors, clinical pharmacists, data analysts and account execs have actually led to a decrease in new claims with opioids for the last two years.
Think about that. Working with payers, PBMs have been cutting opioid scripts for new claims by 5-7 percent per year for the last two years, likely significantly reducing adverse consequences – addiction, misuse, diversion, death.
PBMs make their money when patients are prescribed and dispensed drugs. Yet PBMs, and their payer customers, have been working tirelessly to reduce the number of pills their patients take.
I’d be remiss if I didn’t acknowledge PBMs’ customers – adjusters and execs alike – have been a key part of the solution. I recall a terrific program instituted by OneBeacon a decade ago that rewarded adjusters for identifying claimants on opioids and referring those claimants to a physician for review and treatment modification efforts.
Somehow the uninformed and unwilling-to-be-informed out there have not seen fit to allocate credit where credit is due.
Yes, work comp can be archaic, byzantine, frustrating, and even stupid. And yes claimants can be mis-served for any number of reasons.
But what you’ve done about opioids is truly remarkable. Yeah, we still have a long way to go. But we are well ahead of the rest of the world.
Note – I am president of work comp PBM consortium CompPharma.