Prescription opioids are a major reason for the skyrocketing cost of workers' compensation insurance, as evidence points to harmful consequences from the long-term use of the medication, says a report from insurance broker Lockton.
In a report titled, “Opioids Wreak Havoc on Workers' Compensation Costs,” Keith E. Rosenblum, senior risk consultant for Lockton Companies, says the abuse of opiates by injured workers is a major problem, both in terms of cost and individual health.
“Prescription opioids are presently the number one workers' compensation problem in terms of controlling the ultimate cost of indemnity losses,” he writes.
The report estimates 55 to 86 percent of all claimants receive opioids for chronic pain.
Rosenblum says this is a relatively new phenomenon in the 100-year history of workers' comp.
Overdose deaths have increased 300 percent since 1999, and misuse and abuse of the prescription painkillers was responsible for 475,000 emergency room visits in 2009, double what they were five years ago, he says, according to government data.
Prescription drugs account for 19 percent of total medical spend on an average workers' comp plan, Rosenblum says. Opioids account for an average 25 percent of the prescription spend, “and 35 percent or greater for claims over three years old.”
While those are the direct costs, there are indirect costs as well, Rosenblum says, such as workers not returning to work if they are on the medication more than 90-days as they become either addicted to or tolerant of the drugs. These workers also “suffer a multitude of associated illnesses and debilitating side effects secondary to drugs' use,” says Rosenblum.
“These losses become exceptionally expensive and very difficult to settle,” he says.
One way to battle this crisis is the utilization of Pharmacy Benefit Management (PBM) stewardship reports aimed at informing management of the cost and severity of the drugs on their program.
He says information often supplied to a company's management “is falling short of telling the whole story” and the PBM are “crucial” to the evaluation of how the workers' comp program is performing.
An adjuster's job is also very important “to stay on top of claims with prescribed opioids, either within the first 10 days of an acute injury or where these opioids are being prescribed beyond 45 days.”
This includes closely monitoring medical reports for illnesses that could be associated with prolonged opioid drug use; assessment of the possibility of addiction and closely following patient progress.
“Above all else, engage and challenge the treating doctor as to the validity of continuing opioid prescribing, where periodic medical reports do not indicate progress in work and life skills functions and reduction in pain,” says Rosenblum.
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