WCRI Reports Opioid Use Down, But Strict Regulation Remains
Drug regulations and spend are important for any workers’ compensation program to monitor.
If a program doesn’t adhere to state and federal regulations, it could run afoul of the law and prompt lawsuits or worse. Add to that the ravages of the opioid epidemic, which the insurance industry, to its credit, blew the alarm on well ahead of any meaningful consciousness on the issue on the part of the public sector.
Two recent reports from WCRI attempt to clarify the current landscape of prescription drug use in workers’ comp, for the benefit of payers and insureds.
Drug Regulations and Trends
The first report is its “Workers’ Compensation Prescription Drug Regulations: A National Inventory, 2020.”
It breaks down workers’ comp pharmacy fee schedules, formularies, treatment guidelines and the statute in each state that governs workers’ compensation drug laws, among other information. It’s a one-stop shop for prescription drug questions.
In addition to breaking down regulations state by state, the report dives into hot topics in workers’ compensation, including medical marijuana regulations, rules for monitoring and limiting opioid prescriptions and workplace drug testing regulations.
Unsurprisingly, the most prominent area of prescription regulations highlighted by WRCI are centered around opioid use, prescriptions and treatments.
Tables within the report detail the differing state regulations when it comes to opioid prescriptions and related issues, such as workplace drug testing.
Medical marijuana is another major area of focus in the WRCI report. In almost two-thirds of jurisdictions, it is legal for doctors to authorize or recommend the use of marijuana for medical purposes.
Where Is Drug Spend Going?
The second report, “Interstate Variation and Trends in Workers’ Compensation Drug Payments: 2016Q1 to 2019Q1” looks at workers’ comp drug spend. It found that spending on opioids and compound drugs is down while spending on dermatological drugs increased.
Here are some interesting stats from the report:
- Overall, drug spend is on the decline. In 22 of the 28 states this study looked at saw drug payments per medical claim decrease by 15% or more, with California seeing a decrease of 75%.
- Spend on opioids decreased in all 28 states, though with varying degrees. Payment shares for opioids in the median state decreased from 20% to 9%.
- Spend on dermatological drugs increased over the study’s three year period in 9 of the 28 states.
- Payment shares for dermatological drugs increased by more than 10% in that time.
When reviewing the pharmacy part of your workers’ compensation program, don’t stop at making sure your program complies with state regulations. It’s important to make sure you’re getting the best prices from your PBM as well.
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Workers’ comp legislation is constantly shifting. These legislative updates will help your program keep up to date on shifting regulations. &