While there has been a reduction in addiction and the abuse of opioids, these drugs continue to be an issue of concern for insurers and employers regarding workplace injuries and workers’ compensation claim costs.
The primary reason surrounding these issues is in part due to higher lost wages caused by delays in return to work, as claim costs for injured workers using prescribed opioids are significantly higher than for workers with similar injuries who aren’t using the drugs. In fact, according to a Johns Hopkins University study cited by the National Safety Council, average claim costs associated with prolonged opioid use have been shown to increase average claim costs as much as nine times compared to claims for workers being treated for similar injuries who aren’t on the drugs. Additional claim costs can also be attributed to treatment for drug addiction and dependency.
Key Trends and Updates
According to the Workers Compensation Research Institute (WCRI) study released in February:
- While all U.S. states have introduced legislation to address the use of prescription drugs such as opioids, slightly less than half of U.S. states, 23, have yet to adopt medical treatment guidelines for workers’ compensation cases to identify how those guidelines affected the care, cost, and worker outcomes. Moreover, guidelines adopted or developed by the 23 states significantly differ.
- In the states without treatment guidelines and “where there is no single payer representing a predominantly large market share,” employers and insurance carriers can set their own guidelines, which the WCRI noted may result in inconsistent care for injured employees.
- Currently, the only standards for utilization regulations surrounding prior authorizations or aftercare for an injured employee are a state’s individual medical treatment guidelines.
- To date, 37 states are set to penalize payers that fail to adhere to state treatment guidelines and utilization regulations, with 22 states taking other punitive measures for noncompliant providers. Currently, payers in Maine, Minnesota, and Ohio that are not in compliance with treatment guidelines can have their participation in the state’s workers’ compensation system revoked.
Additionally, some states have already begun taking proactive measures to curb the overuse of opioids by injured workers. For example, a recent study conducted by the California Workers’ Compensation Institute found that substituting non-steroidal anti-inflammatory drugs for opioids for certain injuries reduced the number of opioid prescriptions filled by as much as 18% in the first half of 2018.*
Staying informed on legislative issues and changes regarding opioid use in workers’ compensation can help insurers, employers, and stakeholders better understand their individual state’s medical treatment guidelines, utilization reviews, and dispute resolution process.
For more information, contact Todd Pollock at (508) 625-3547 or firstname.lastname@example.org
* NAISDs Overtake Opioids as Top Workers’ Comp Drug in California, Insurance Journal, Feb. 15, 2019