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Opioids prevalent in Medicare set-aside settlements: Study

Posted On: Nov. 1, 2017 2:41 PM CST

Opioids prevalent in Medicare set-aside settlements: Study

An analysis on opioid prescribing and workers compensation shows that nearly 70% of federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers require funding for decades of opioid use.

The study released Monday by the California Workers’ Compensation Institute also found the prescriptions were often at dangerously high levels and in conjunction with other high-risk drugs.

Medicare set-asides are insurer-paid plans in which claims administrators allocate funds from workers comp settlements to cover future medical expenses arising from a work injury that might otherwise be paid by the federal Medicare program.

The Oakland, California-based research nonprofit found that opioids are the most commonly prescribed drug for set-asides, accounting for 28% of all prescription drugs and 33% of all prescription drug allocations, which the institute says represents “significantly higher proportions than in the general workers comp population.”

The study also examined drug strength, using data on morphine milligram equivalents in approved Medicare set-aside plans to find that the comp-based plans are 45 times the cumulative morphine milligram equivalents — a standard for measuring opioid drug strength — that were used from the date of injury to claim closure in a control group of permanent disability claims with similar injuries. 

For set-aside settlements with opioids, injured workers were on average approved for a daily dose of 54.7 morphine milligram equivalents for an average of 20.9 years, with over 10% of set-aside plans with opioids having an estimated morphine equivalent dose level of over 90 morphine milligram equivalents per day, a marker of elevated risk to the patient, the study states.

Additionally, 14.5% of plans with opioids had concurrent prescription reserves for sedative-hypnotics, while 4.8% of plans with opioids included sedative-hypnotics mostly used for sleep disorders and muscle relaxant prescriptions, the study found. 

To gather information, the authors of the study compiled a sample dataset of California set-aside cases from four national vendors that represent more than half of the state’s market for Medicare set-asides. The final sample dataset consisted of 7,926 cases completed, submitted and approved between January 2015 and December 2016.