Industry Trends: Insurance Companies Addressing Opioid Addiction and Abuse

Industry Trends: Insurance Companies Addressing Opioid Addiction and Abuse

National headlines speak of an unprecedented opioid epidemic sweeping the country. Opioids are a class of drugs that include heroin as well as prescription pain relievers—among them oxycodone, hydrocodone, codeine, morphine, and fentanyl. Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce ‘pleasant’ effects and relieve pain. However, they are highly addictive.

According to the Department of Health & Human Services (HHS), on an average day in the U.S.:

  • More than 650,000 opioid prescriptions are dispensed
  • 3,900 people engage in nonmedical use of prescription opioids
  • 580 people engage in heroin use
  • 91 people die from an opioid-related overdose

The economic impact of this epidemic is staggering, with $55 billion in health and social costs related to prescription opioid abuse each year, and a $20 billion spend in emergency department and inpatient care for opioid poisonings.

Drug overdose is the leading cause of accidental/injury death in the U.S.  And it is no surprise, based on the fact that the United States consumes 80% of the world’s supply of opioids₁.

These are all alarming facts and unfortunately, there are additional side effects of the opioid epidemic that extend to the workplace.  Abuse leads to absenteeism, increased worker compensation claims, presenteeism (working while not healthy or focused), tardiness, and workplace safety issues—just to name a few.

HHS has been progressive in developing new initiatives, however, many insurance carriers and pharmacy benefit managers have taken stronger stances on the prescribing of opioid related drugs.  Many have put in place controls and management programs to identify and prevent the abuse and habitual use of these highly addictive drugs.

For example:

  • Strengthening prior authorization, quantity limit, and step therapy (first line medications) policies specifically related to the opioid and narcotic classification of drugs.
  • Partnering and notifying providers when patients appear to be obtaining prescriptions from multiple providers and receiving a harmful level of opioid prescriptions.
  • Providing increased access to substance use disorder (detox) drugs and stronger services and support for both patient and families as well as more robust facility inpatient and outpatient clinical programs.

The programs and initiatives are all aimed at limiting the use and likelihood of becoming addicted to opioids, as well as intervention of abuse at early stages. Over prescribing has played a role in the epidemic and providers have now been challenged to pull back the reigns and be more responsible in pain medication prescribing.

All constituents in the health care arena need to be engaged and vigilant in the management of this potentially deadly epidemic. Through this coordinated effort, there is an opportunity to dramatically influence and reduce opioid misuse in the U.S.

By Chris Elvidge, Director of Account Management

  1. Cleveland Clinic,”Opiates Kill More People than Car Accidents,” 26 September 2014.