WSI Adopts Chronic Opioid Therapy Guideline

Wednesday, May 4, 2016 | 0

North Dakota Workforce Safety & Insurance has adopted a new policy that governs the management of opioids that are prescribed to claimants for longer than 90 days.

WSI said it adopted its "chronic opioid therapy" medical policy in response to legislation passed by state lawmakers in 2015. The legislation authorized WSI, the state's monopoly insurer, to request random drug testing for the purpose of monitoring and determining ongoing coverage of chronic opioid therapy.

WSI said it will review medical documentation and claim data to assess the progress of an injured employee’s opioid therapy, including compliance with treatment protocol. The assessments will help WSI determine whether an injured employee is eligible to receive continued coverage of opioid therapy.

The carrier's treatment guidelines for opioids prohibit reimbursement for opioids past 90 days from the initiation of a claim unless the drugs increase function, enable the claimant to resume working and improve pain control without debilitating side effects.

Also, opioid therapy should be used only for patients who are not responsive to non-opioid drugs, do not use illegal substances or abuse alcohol and comply with treatment protocols.

Providers are required to provide documentation on the effectiveness of opioid treatment at least every 90 days, including documented improvements in pain control and function. Patients are required to sign treatment agreements and may have only a single prescriber for opioids.