Outside the workers’ comp world, opioid utilization and costs are increasing significantly, driven by greater use of long-acting opioids.
According to a Prime Therapeutics study of 15 million commercial insurance claims, short-acting opioid prescriptions dropped over a 15-month period, but utilization of all types of long-acting opioids increased.
In contrast, we work comp Neanderthals have been driving down opioid usage for years.
a few data points…
- the percentage of new claims receiving opioids has been decreasing since 2012
- the number of opioid scripts per claim has also been dropping
- utilization of controlled substances dropped 7 percent in 2014
- Coventry First Script clients’ opioid utilization decreased by 3.2 percent from 2014 to 2015
- Express Scripts’ work comp clients’ opioid usage also declined significantly – 4.9%
What accounts for the disparity between workers’ comp and group health?
Work comp payers care deeply about outcomes, function, and return to work. Patients taking opioids are much less likely to return to functionality than those on NSAIDs or no drugs at all.
Some payers have dedicated units focused on chronic pain and prescription drug management. Others rely primarily on their PBMs, but almost all insurers and TPAs have been working this issue for years.
PBMs working in the comp sector dedicate a lot of resources to managing opioids. Investments in analytics, PBM – payer interfaces, staff training, clinical guidelines and the like are costly but drive these results. Staffing – clinicians, pharmacists, data analysts, program managers, highly trained customer service staff – focus on this issue 24/7.
That’s not to say we don’t have a very long way to go; data from CompPharma’s annual survey of prescription drug management in workers’ comp and NCCI indicate spend for controlled substances (mostly opioids) accounts for about 28% of total WC drug spend.
I’m gong to be speaking at this month’s National Heroin and Prescription Drug Abuse Summit on what the real world can learn from workers’ comp. The main takeaway -despite significant regulatory, economic, and legal barriers inherent in workers’ comp, payers and PBMs have made significant progress.
It’s time for the real world to get on board.
What does this mean for you?
We CAN reduce opioid use – it just takes dedication, resources, and persistence.