The opioid epidemic remains a top news story and has been ever since public awareness began to dramatically increase in 2012 due to numerous celebrity deaths and renewed focus by federal agencies like the Centers for Disease Control and Prevention (CDC). However, the impact to injured workers was being realized in workers’ compensation well in advance of national awareness due to years of overprescribing in a population that typically requires treatment for pain. Data shows that, in 2016, injured workers received three times as many opioid prescriptions as the overall US opioid prescribing rate.(Source: NCCI) 

For injured workers, the results of opioid use can be devastating, including addiction, dependency, depression, increased sensitivity to pain, impact to hormones and even in extreme cases death. Opioid side effects can severely impact the quality of life of an injured worker and result in the delay of returning to work and productivity after an injury. The results for the employer are increased pharmacy costs and increased time away from work. This will also impact an employer’s ability to deliver goods, products and services, negatively impact safety, quality and morale. A recent study showed that workers who had long-term opioid prescriptions received temporary disability benefits 251% longer than those who did not take opioids. (WCRI)

Efforts to reduce opioid use among injured workers and reduce pharmaceutical costs are a top priority for employers. Pharmacy utilization review (UR) programs are one way to help prevent opioid abuse.  These programs involve early intervention at the point of sale before the medication is even dispensed. When a doctor prescribes a potentially harmful medication, a nurse receives an alert. This provides an opportunity to discuss alternative treatment strategies with the prescribing physician and avoid unnecessary opioid prescriptions.  

Of course, these programs come at a cost; while many opioid prescriptions are relatively inexpensive, it is necessary to evaluate the cost-benefit analysis of trying to fight the war on opioids. When you consider the various negative outcomes that come with opioid use, the value of such a program to the employer and injured worker goes far beyond the cost of a single prescription. To tell the full story, it’s important to consider the overall impact opioids have on your cost of risk and the duration of the claim. Opioid claims can make up between 10 to 40% of pharmacy transactions but, often more importantly, can represent significant barriers to resolving a claim. In general, the incurred cost of a claim doubles when it has an opioid fill compared to one that does not. Furthermore, data shows that the total incurred costs increase by another 80% with the second opioid fill. And the picture gets even bleaker at three fills, when the incurred costs only continue to escalate again to almost seven times compared to claims with no opioid fill. When focused on the bigger picture it is clear that there is true value in reviewing inexpensive medications like opioids because of the overall impact on loss costs.

Pharmacy utilization review is an important aspect of managing the overall cost of risk. It is important to focus on the overall impact and not just the investment at the drug transaction level, there is no doubt that it results in lives saved, addictions avoided and lower claim costs with safer, healthier employees.

Dr. Teresa Bartlett, Senior Medical Officer

> Save the date to join Dr. Bartlett for an upcoming webinar in partnership with DMEC’s Hospital System Industry Group – Managing painstaking consequences of prescription drug abuse – on March 27