Reducing Narcotics Abuse in Workers' Compensation

The use of narcotics was evidenced in a recent article in the Journal of Workers Compensation, which estimated that narcotics account for an almost 40 percent of workers' compensation medication costs. And while narcotics can be beneficial in the treatment plan of an injured worker, there are serious risks involved when they are not used properly.

The Centers for Disease Control (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA), both indicate increasing misuse and abuse of narcotics over the past decade. SAMHSA data shows that there was a significant increase from 2000 to 2006 in the treatment of substance abuse cases related to abuse of opiod analgesics.

The Narcotics' Quandary

According to the 2009 Progressive Medical Drug Spend Analysis, spending on narcotics has remained relatively stable during the last year. As indicated earlier, however, narcotics still account for nearly 40 percent of all workers' compensation claim costs.

What is even more troubling for workers' compensation insurers is the allocation of that spending. In a study released by the National Council on Compensation Insurance, narcotics total share of medication expenses increases as a claim ages, from 15 percent in year one to as much as 35 percent in the fifth year.

Additionally, the longer an injured party is on narcotics, that more it delays the injured party's ability to return to work. There also is an increased likelihood that the payer may need to pay for rehabilitation programs for addiction.

Take Proactive Measures to Combat Abuse

Because the cost of prescriptions, including narcotic medications, directly impacts the cost of a workers' compensation claim, insurers need to quickly identify and control instances of misuse and abuse. One of the most efficient methods to control narcotic use is to partner with a pharmacy benefit manager (PBM). A PBM can clearly define a strategy to proactively and effectively monitor narcotics, and help payers ensure the safety of the injured party while reducing expenses.

There are several best practices that can be deployed by PBMs to assist payers:

? Defining customized narcotics utilization strategies

? Managing prospective and concurrent drug utilization programs

? Conducting retrospective drug utilization reviews and clinical intervention programs

? Providing ongoing consultation and evaluation of utilization strategies

? Validating narcotics use through reporting

It is expected that narcotics will continue to play a role in treating pain in workers' compensation. While greater oversight of narcotics use is already underway by the FDA through its new Risk Evaluation and Mitigation Strategies requirement, workers' compensation payers must take proactive measures to reduce misuse and abuse. A relationship with a strong PBM partner experienced in workers' compensation will enable the payer to monitor utilization and reduce point-of-sale fulfillment of unnecessary narcotics. By doing so, payers decrease risk for litigation, improve injured party safety, and obtain more control over medication expenses.

Tron Emptage, RPh, MA, is executive vice president of business development at Progressive Medical, Inc. He may be reached at Tron.Emptage@progressive-medical.com or 800-777-3574. Company information is available at www.progressive-medical.com.