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Soaring opioid treatment costs create headache for comp sector

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Workers compensation experts say they’re seeing escalating costs for treating opioid addiction in the United States and predict the current addiction climate will get a lot worse before it gets better.

“These are clean-up costs … We’ve created a mess over the past 20 years that we now have to fix,” said Mark Pew, senior vice president at Prium, a Duluth, Georgia-based medical cost management firm. “It’s the new normal.”

Turning heads recently is a September report by New York-based nonprofit Fair Health Inc., which examined overall medical claims data from 2011 to 2014 and found a 1,000% increase in treatment costs related to opioid abuse and dependence, along with a 1,375% increase in the maximum amount an insurer will pay in expenses related to opioid addiction.

This was the second report Fair Health released in 2016. The first found a 3,000% increase in the volume of insurance claims related to opioid dependence between 2007 and 2014.

Fair Health President Robin Gelburd said the studies were conducted to help fuel much-needed public discussion on opioid addiction and to help ignite changes among policymakers, doctors and insurers.

Although workers comp represents a fraction of the overall opioid addiction problem, comp experts say they’re concerned about the rising costs of legacy claims for opioid-dependent injured workers.

“Those are the ones that end up lingering and becoming problematic in the future,” said Chrystal Woodard, a Tampa, Florida-based senior consultant for claims with Aon Risk Solutions. “Once they are on it, you see a problem getting them off of it.”

Opioid addiction costs have long been a concern in the comp industry, since an addicted worker is less likely to return to work. That means comp insurers and employers pay benefits to injured workers for longer periods of time, up to and including death benefits to surviving family members if a worker dies from an overdose — as is mandated in several states.

Additionally, rising costs for opioid addiction treatment have taken a toll on workers comp payers when addiction treatment is covered under an injured worker’s comp claim.

Mike Farrand, Philadelphia-based senior principal for integrated casualty consulting with Willis Towers Watson P.L.C., said opioid utilization among newer claims is down, but costs overall are up — a sign that a shift is taking place.

“The older claims tend to be driving the utilization,” he said. “Older claims are making up 50 % of the medical costs (when) I look at the data and payment trends. After a claim reaches the two-year mark, upwards of 80% of the medical costs tend to be prescription costs, and getting control of that will still be a long-standing problem.”

It’s not just addiction treatment fueling long-term costs associated with opioids. Opioid addiction comes with a host of side effects — everything from severe constipation and anxiety to erectile dysfunction and insomnia — which in turn help fuel increasing costs related to addiction and management of symptoms, said Joe Paduda, Skaneateles, New York-based president of CompPharma L.L.C., a workers comp pharmacy benefit management consortium.
“The side effects of opioids have to be mitigated often with other drugs,” Mr. Paduda said.

“You now have pharma companies saying there is a market for these drugs to deal with side effects,” he added. “It is extremely difficult for people to get off of opioids and deal with their dependency.”

State lawmakers have been tackling the opioid problem with strategies such as creating closed prescription drug formularies to limit opioid prescriptions for injured workers and using prescription drug monitoring databases to track opioid prescribers and recipients.

The Ohio Bureau of Workers’ Compensation recently revamped its rules for how doctors can prescribe opioids, creating a best practices approach to managing pain and treatment for addiction. Those rules went into effect Oct. 1 with much fanfare from regulators grappling with the issue there, according to Sarah Morrison, the bureau’s Columbus, Ohio-based chief executive officer.

“We want and expect (doctors) to be thoughtful when prescribing opiates in the workers compensation field,” she said. “We are looking very seriously at our role and making sure that opioids are prescribed appropriately.