The opioid epidemic has had a devastating impact on society and a profound toll on public health and opioid-involved deaths. The multifaceted aspects of the opioid crisis have had an effect clinically, financially and negatively influence workers compensation. While there has been a significant decline in opioid prescribing, new medications are diversifying the drivers of pharmacy costs in workers’ compensation. Kimberly Marsh, Vice President, National Accounts, ANS Solutions moderated the discussion that featured remarks from co-panelist Stanley Evans, Partner, Gerber Ciano Kelly Brady LLP, Marty Rosemann, Head of Transaction and Legacy Management, Senior VP, Swiss Re, Anthony Sambucini, Chief Executive Officer, ANS Solutions and Troy Smith, Assistant Vice President Claims, Arch. A video replay of this session is available to members on AIRROC’s On Demand platform.
The following are some of the top key takeaways from the presentation:
Opioids are on the decline but pharmacy costs persist. Over the last decade, federal, states and insurers in the workers’ compensation industry have been working extensively to control the use of opioids. This rising epidemic has led to a broad assortment of responses that have helped curb opioid abuse and overprescribing by physicians, yet they have caused a cascading problem. The costs associated with opioids have shifted. Pain is real. So while the response and laws aimed at limiting the supply of opioids and lowering barriers to treatment for substance abuse have borne fruit, new trends are emerging from dermatologicals to anticonvulsants, specialty medications and emerging psychedelics. Of course, all bring unique challenges related to efficacy, safety, cost and potential for abuse – all which deepen the need for insurers to continually monitor closely moving forward.
Reducing exposure. Understanding the baseline trend and your cost drivers are essential in developing a strategy to mitigate exposure. One such strategy from a cost perspective is checking for generic medications so that you are not paying for costly name brand drugs. In other cases, physicians may be able to wean injured workers off opioids when they are no longer medically necessary for the injury. Engage with physicians to consider alternative forms of treatments that are non-narcotic that will not compromise care but less expensive and lead to better patient outcome. Awareness and actively managing the book by digging into the details can be successful. Changes such as these, although small, overtime can add up and result in savings of tens-of-thousands of dollars in the final claim outcome and the overall workers’ comp book.
Settlement strategies. Lowering pharmacy costs can position you for settlement. Communication with plaintiff’s counsel and the claimant to establish and foster a team approach that is beneficial for all parties can lead to finding a way to resolve the claim. Providing information on the use of alterative medications or treatments that potentially improves patient’s lives can help achieve an optimal outcome. Understanding a claimant’s reservations can help overcome objections and get closer to a settlement.
