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The U.S. Centers for Disease Control and Prevention last week called for tapping workers compensation claims data and cracking down on “pill mills” to avoid an epidemic of prescription pain medication overdose deaths.
Those and other CDC recommendations accompanied a report concluding that U.S. deaths from prescription pain-killers more than tripled during the past 10 years, with more than 40 overdose deaths occurring daily.
While some insurers, self-insured employers and state agencies already track prescription data to prevent abuse and misuse of prescription narcotics known as opioids, others could undertake such measures or refine their practices, said Christopher Jones, a health scientist for the CDC in Atlanta.
“We want to make sure that it's a concerted effort for all the companies out there, whether they are health insurers, pharmacy benefit managers...or workers comp claims programs,” Mr. Jones said. “Because, one, they can save money, but it also can save lives.”
The growing issue of prescription painkiller abuse is the subject of Business Insurance's newly launched workers comp channel solution arc at www.businessinsurance.com.
Other federal and state efforts, meanwhile, are focusing on arresting pill mill operators.
The law enforcement efforts have been particularly focused in Florida, although other states are not immune from pill mill operations.
Pill mills tend to be storefront operations, often operated by “rogue doctors” who “are in fact drug dealers,” and Florida is “ground zero” in the fight against them, the U.S. Drug Enforcement Agency said in a June statement.
Florida's pill mills “are now the primary source of drug diversion in the Eastern United States,” according to a statement from the state attorney general's office.
“Florida leads the nation in diverted prescription drugs, resulting in seven Floridians dying every day and countless others throughout the nation,” according to the attorney general's office. “Our state has become the destination for distributors and abusers through the proliferation of pill mills.”
Observers say Florida became a pill mill haven because of the state's history of lax prescription drug enforcement, which officials are working to change.
One operation spearheaded by the DEA against illegal drug dispensaries in Florida was dubbed “Pill Mill Nation.” It coordinated the efforts of federal and state agencies including the Florida Department of Financial Services' Division of Workers' Compensation, to help monitor any insurance billing.
But the pill mills typically require payments in cash, sources said.
Because of that and other reasons, it's likely that workers comp claims payers have not substantially contributed to their revenue, state and federal sources said. And it is possible that workers comp claimants who have become addicted to opioids through treatment provided for their workplace injuries may find their way to pill mills.
However, studies to determine the extent of such behavior have not been conducted, the sources added.
“I am not aware of any data specifically tracking patients who were at one time in a workers comp program subsequently receiving their prescriptions from pill mills,” the CDC's Mr. Jones said. “Certainly, we know people who are suffering with addiction to prescription painkillers may seek drugs at a pill mill.”
According to last week's CDC report, “prescription painkiller sales per person were more than three times higher in the highest state, Florida, than in the lowest state, Illinois.”
But Florida is not the only state grappling with the problem.
A health care fraud team for Ohio's Bureau of Workers' Compensation has been investigating and prosecuting doctors operating pill mills, although the mills are not the only problem, a bureau spokeswoman said.
Ohio's bureau also has publicized its recent prosecutions of claimants for “deception to obtain a dangerous drug,” or visiting several doctors to fill the same prescription.
In one among several such cases, an Ohio claimant pleaded guilty after investigators found that he provided his adult granddaughter with narcotics prescribed by his workers comp doctor. The granddaughter sold his Opana for $50 per pill and his Percocet for $12 per pill on the street and split the profit with the claimant, according to the bureau.
To stem the use of prescription pain medication nationwide, the CDC wants state health and insurance regulators to encourage “use (of) prescription drug monitoring programs, public insurance programs and workers compensation data to identify improper prescribing of painkillers.”
In its “Vital Signs” report, the CDC also encouraged state regulators to adopt and enforce laws that prohibit pill mills and doctor shopping. It also encouraged licensing boards to “take action against inappropriate prescribing.”
In total, opioid pain relievers were involved in 14,800 U.S. deaths in 2008, or 73.8% of the all prescription drug overdose deaths, the CDC reported.
“The take-home point—and this is why we are calling on insurers and others to take action—is to improve how the drugs are prescribed,” Mr. Jones said. “And certainly insurers have influence on how practitioners practice. They have reimbursement mechanisms, they have claims review processes; and we think that they can help positively impact the ways prescribers are using these drugs, which in turn helps make sure that patients that need these drugs can get them, but it also reduces the number of people that are abusing them and dying,” he said.
For in-depth coverage of this topic and related issues, visit our Solution Arc on Opioid Abuse and Workers Compensation: Tackling a Growing Problem.