Employers Paying a Large Portion of Opioid Crisis Costs

Saturday, November 16, 2019

Employers need to understand and appreciate that the opioid crisis isn’t just impacting disenfranchised and unemployed Americans. Working adults are addicted to opioids too. You need to take steps to combat the issue because it’s impacting more than just your healthcare costs.

Take a look at the 2016 numbers released by the Kaiser Family Foundation:

  • The annual cost of treating opioid addiction and overdoses for people with employer-based healthcare coverage was $2.6 billion.
  • 5% of workers age 55-64 had at least one opioid prescription.
  • Opioid use varies by region:
  • South: 16%
  • Midwest: 14%
  • West: 12%
  • Northeast: 11%.

The American Society of Addiction Medicine estimates that opioid abuse costs employers another $10 billion due to absenteeism and presenteeism. That brings employers’ total costs of opioid treatment and its related consequences to $36 billion dollars.

What’s Being Done to Address the Issue?

According to Surgeon General Jerome Adams, an estimated 2.1 million people in the US struggle with opioid use and abuse. Measures have been or are being enacted to address this issue.

  • The US House of Representatives is considering:
  • Speeding approvals for non-opioid painkillers
  • Strengthening drug enforcement programs
  • Improving care for children impacted by addiction
  • Reducing prescription levels
  • Improving prescription monitoring programs.

An estimated 2.1 million people in the US struggle with opioid use.

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Not surprisingly, drug manufacturers, insurance companies, and the American Medical Association don’t support these efforts, and their reticence seems to be softening the stance the Federal government will eventually take.

  • Most states created prescription drug monitoring databases to track patients for whom physicians prescribed opioids. While well intended, the effort led many patients who couldn’t get prescription painkillers to use illegal drugs, such as heroin and/or fentanyl. About 75% of the people who entered treatment for heroin became hooked after filling a legal prescription from a physician (The National Institute on Drug Abuse).
  • According to Governing, hundreds of states and cities are suing drug manufacturers, alleging deceptive marketing practices and a lack of warning on the dangers of addiction.

About 75% of the people who entered treatment for heroine became hooked after filling a legal prescription from a physician.

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What Should Employers Do?

Dr. Adams outlined some steps employers can take to protect their employees and their bottom lines.

Educate employees. More than 33% of people who are prescribed pain medication don’t realize they’re taking an opioid. With names like OxyContin, Vicodin, morphine or methadone, patient confusion on what medications contain opioids is inevitable.

Dr. Adams encourages you to work with your plan to help employees and their families understand what an opioid is and where it can be found. You can create a plan provision that whenever opioids are prescribed, your members must be informed that they’re taking an opioid and that they could become addicted.

Limit the number of pills prescribed at one time. Limit the number of pills/units that can be prescribed by your providers, including dentists, physicians, and hospitals.

Follow CDC guidelines. Following clinical practice care guidelines can help ensure that your members have access to safer, more effective chronic pain treatment. It also helps reduce the number of people who will misuse, abuse, or overdose from opioids. Make sure all providers in your network follow the CDC Guideline for Prescribing Opioids for Chronic Pain.

Identify pain management centers of excellence. Centers for excellence employ highly skilled experts in their fields to advance research and treatment. Identify a center that specializes in pain management for steerage opportunities.

Pay only for effective treatment programs. Fair Health reported that private insurers spent $721 million to treat opioid addition in 2015, a 1000% increase since 2010. You want to make sure that money is well spent for both you and your members.

There are more than 14,000 specialty addiction treatment programs in the United States, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). There aren’t national standards, so programs vary widely.

And so does program quality. Florida has been called the Rehab Capital of the World, and California is known as the Rehab Riviera because of the number of fraudulent rehab programs operating within their borders.

So how can you be sure the treatment you offer your members will be effective? Dr. Adams identified the following best practices to look for in a reputable treatment center:

More than 33% of people who are prescribed pain medication don’t realize they’re taking an opioid.

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Assess medical and pharmacy claims. You need to integrate and analyze your medical and Rx claims data to understand if you have issues and what those issues are. Analyzing your claims data can reveal good insight that can improve your programs, like:

  • How many members are being prescribed opioids and how many pills/unit they’ve been prescribed
  • Which providers are prescribing opioids at an unusual rate
  • Where prescriptions are being filled
  • If there are geographic differences
  • How you compare to other companies in your region and nationally.

Work with your benefit advisors, carrier(s), and EAP program vendors to design effective programs that will help your employees and prevent future addictions to opioids.


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