I just finished reviewing two of the most recent industry pieces on opioids in workers' compensation: first, CompPharma's Tenth Annual Survey on Prescription Drug Management in Workers' Compensation and second, the IAIABC's Policy Guide for Reducing Inappropriate Opioid Use in Treatment of Injured Workers (you have to register to get a copy).
The most significant insight from Joe Paduda's CompPharma survey is that despite the appearance of the industry having drug spend under control, respondents to the survey still see opioids as a "very significant problem, giving it an average of 4.8 [on a scale of 1 to 5]. This remains the highest score for any question in the history of the survey."
My take: While the most of the PBM drug trend reports and industry trade journals seem to celebrate when opioid spend is flat or slightly declining year over year, the payer community is smart enough to realize that a 2-3% drop in opioid spend isn't nearly sufficient to stem the long term clinical and economic impact of inappropriate utilization. Letters to physicians, generic conversion programs, and peer reviews aren't enough. I don't think we'll see that 4.8 score come down until we're seeing opioid utilization dropping by double digits in year over year results.
As the report concludes, "If the industry and individual companies within the insurance and reinsurance industry do not meet this challenge head-on, acknowledge it and develop effective programs to prevent, identify and treat abuse, misuse, addiction and dependency, we will almost
certainly see the bankruptcy of several workers’ comp insurers over the next decade. It remains to be seen if insurers grasp the seriousness of this issue before it is too late."
Regarding the IAIABC Policy Guide, I have been tough on this organization over the last year due to the fact that the Executive Committee shelved the model legislative and regulatory language it had worked on for a year. That said, this new policy guide will serve as an a solid conversation starter in state capitals through the country. Policy recommendations include inter-agency coordination, adoption of treatment guidelines, exploration of pre-authorization and formulary requirements, the necessity of drug tapering, the need for continuing education for physicians, the need for every state to have a functioning prescription drug monitoring program, and a discussion of what a "fast track" dispute resolution process should look like when questions of medical necessity cannot be collegially determined. The guide also includes many helpful references to specific and successful state programs.
The IAIABC Policy Guide isn't perfect. Perhaps out of sheer necessity and obvious resource constraints, the guide glosses over the gritty detail in its examples of certain legislative language and regulatory programs - and as we all know, that's where the success or failure of such things if often determined. That said, the guide is a great overview of the topics that a state workers' compensation program or legislative body needs to consider and it contains enough detail to inform conversations about how best to deal with the crisis of opioid misuse and abuse within the system.
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