How Much will Opioids Really Cost You?

Tuesday, March 20, 2012 | 0

A lot more than you think.

I met with a large workers comp payer recently to discuss (among other things) their strategy regarding long-term work comp claims; they have more than 40,000 claimants that have been on opioids for extended periods.

The research strongly suggests most of these claimants are addicted/dependent. Others may be diverting, and still others may be hyperalgesic (much more sensitive to pain as a result of long-term usage of opioids).

None of these are good, and most have serious and very costly implications for claim costs.

Very few individuals on opioids are going back to work (while on drugs)

Very few payers are screening for addiction, so they really don't know if/how many of their claimants are addicted - and therefore don't know how the potential financial implications (either pay for opioids forever, settle at a very high cost, or treat and successfully resolve the addiction)

Claimants using opioids are at much higher risk for death; one client identified almost sixty claimants that died last year that appeared to die as a result of prescription drugs prescribed for their work comp injury.

I get the sense that most payers haven't adequately reserved for these claimants, although the stiff stance of the Centers for Medicare and Medicaid Services may force them to do so if they have any hope of settling some portion of the block of claims.

This doesn't have to inevitably become a financial disaster for insurers or employers, although it undoubtedly will for those who don't take action.

Payers must work with their pharmacy benefit managers to dramatically reduce their exposure. This requires both parties to:

a) identify long-term users,

b) mine their data to determine which claimants may be abusing/misusing/diverting and involve the special investigations units where appropriate,

c) channel appropriate claimants to addiction screening, allocate the resources necessary for weaning and recovery and recognize this will include behavioral therapy will find they can.

What does this mean for you?

These claims are NOT going to resolve themselves. You own it, and you're going to own it until you've got an effective, working plan in place.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, a Connecticut-based employer consulting firm. This column was reprinted with his permission from his Managed Care Matters blog.