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Workers Compensation Industry Targeting Opioid Use with Employee Injuries

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The Workers Compensation industry is looking at some of the most innovative approaches to fight painkiller addiction among employees. This comes as no surprise, considering workplace injury is one of the main reasons doctors prescribe opioids, and dependence has become an expensive problem for those paying Workers comp claims. In fact, Workers Compensation payers in 2015 spent $1.54 billion on opioids, according to analysis by CompPharma, LLC, a consortium of Pharmacy Benefit Managers (PBMs).

Opioids are prescribed to relieve pain, yet according to several medical guidelines, opioid effectiveness plateaus after 60 days of use, by which time other means, including cognitive and physical therapies, should be employed. Indeed, research shows that for the types of pain related to common workplace-related injuries, including soft-tissue injuries and musculoskeletal problems, opioids are not any more effective than non-opioid alternatives such as Tylenol, Advil or generic ibuprofen. Although opioids are widely prescribed for back injuries and chronic back pain, they should not be the ­first line of treatment, say researchers, as they have been found to create new complications, such as addiction, that can extend a worker’s absence and lead to added suffering and more claims.

Insurers, brokers, and administrators handling Workers Compensation injuries are looking to reverse the opioid-prescribing trend and are trying new programs that push workers toward alternative pain treatments and make it harder to get prescriptions for potentially addictive drugs. For example, Liberty Mutual Group Inc. is using predictive algorithms and behavioral health screens to assess an individual’s risk for dependency, and steering some injured workers to alternate treatments such as over-the-counter drugs and mental-health counseling in lieu of prescription opioids. Such programs are aimed at preventing abuse, rather than treating it after the fact.

Travelers has developed an algorithm that analyzes thousands of claims and identifies the likelihood that an injured employee will develop chronic pain. Certain conditions, such as a prior case history of anxiety or depression, increase the chance that a patient will experience chronic pain, according to Travelers’ medical director, Adam Seidner, who was quoted in a recent Wall Street Journal article. “Those deemed at risk for chronic pain and addiction receive recommendations for alternate therapies, such as physical therapy and mental-health counseling,” Dr. Seidner said.

Travelers says it cannot prevent a physician from prescribing opioids for at-risk patients, but it does urge care providers to follow a plan for alternate therapies and can refuse to authorize payment for a painkiller prescription, depending on state law. According to the insurer, its algorithm, used in 20,000 cases in the past year, has helped reduce individual claim costs by as much as 50%. The predictive model and other efforts have helped reduce opioid prescriptions by 23% in the past 12 months among covered workers, according to the company.

The progress made by the Workers Compensation industry and others, including the FDA and individual states, to reduce opioid usage is positive. We will continue to revisit this important issue and the impact it is having on the comp system. RPS provides a number of Workers Compensation insurance solutions, including guaranteed cost programs, large-deductible plans and self-insurance. For more information, please contact us.

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