Brian Allen, VP of Government Affairs, Pharmacy Solutions
On October 26, 2017, President Trump issued a memo instructing the acting Health and Human Services Secretary, Eric Hargan, to declare the opioid crisis a national public health emergency. In his public statement the President noted, “Ending the epidemic will require mobilization of government, local communities, and private organizations.” The President also singled out a specific, unnamed opioid and declared that it would be taken off the market “immediately.” Additionally, he stated his support for research and development of non-addictive painkillers. “We have to come up with that solution,” he said. Later in his remarks, the President expressed the importance of teaching young people not to start taking drugs. Earlier this same week, a number of state Attorneys General co-signed a letter asking pharmacy benefits managers to do more to aid in curbing the use of opioids.
The opioid crisis has been a persistent problem dogging policymakers for a number of years. This problem crosses all demographic lines, including age, race and socio-economic status. Several statistics shed light on the severity of the issue:
- According to a recent report by the Office of Inspector General for the US Department of Health and Human Services, one out of three Part D Medicare beneficiaries received an opioid in 2016.
- The Centers for Disease Control and Prevention estimate that 20% of Americans received an opioid in 2015.
- The Workers’ Compensation Research Institute recently reported that 30% of injured workers are prescribed an opioid.
- The United States represents 5% of the world’s population but consumes over 80% of the world’s prescription opioid supply.
The overuse of opioids is clearly an American problem, one that has now reached national and international prominence.
The good news is that, in recent years, the workers’ compensation industry has made some positive headway in curbing opioid use. Six years ago, Texas was one of the first states to implement a workers’ compensation drug formulary that targeted the more problematic opioids. Following implementation of this drug formulary, Texas reported a sustainable reduction of opioid prescribing by as much as 81% for opioids on the “N” drug list and an 8% reduction for all other opioids. Other states with formularies, like Washington and Ohio, have also experienced significant reductions in the use of opioids by injured workers. Oklahoma and Tennessee have adopted workers’ compensation drug formularies and California, Arkansas, Montana and New York are very close to joining those ranks.
Other efforts are underway as well. In their June 2017, report titled “Interstate Variations in Use of Opioids, 4th Edition”, the Workers’ Compensation Research Institute reported a continued decline in the use of opioids in a majority of the states studied, with substantial decreased in Kentucky, Maryland, Michigan and New York. The report attributes the decreases to reforms such as mandatory reporting to a prescription drug monitoring program, opioid prescribing restrictions and adoption of treatment guidelines. The Mitchell government affairs team has helped and continues to help shape those policy discussions in a number of states.
At Mitchell Pharmacy Services, we are doing what we can to reduce opioid consumption among the injured workers we serve. Working with our customers, we are diligently applying the tools available in the form of treatment guidelines and drug formularies. Where we can, we put edits in place to help alert adjusters to potential deviations from opioid prescribing limits. Additionally, our unique and proprietary risk scoring is a valuable tool that claims adjusters can use to identify injured workers who may be at risk or approaching a risk point for opioid dependence or abuse. These are great strategies that can help prevent opioid abuse or addiction before it happens.
Still, more can be done. As President Trump stated, “Ending the epidemic will require mobilization of government, local communities, and private organizations.” Allowing PBMs access to the PDMPs would provide an additional set of eyes reviewing a patient’s prescription history. In the workers’ compensation system, policy makers should explore removing any legislative or regulatory barriers that would prevent communication and collaboration among physicians, pharmacists, PBMs, claims adjusters and other professionals when an injured worker presents indications of risk for opioid abuse or addiction. Helping injured workers overcome an opioid addiction or dependence is a team effort and the addicted workers need to feel the support of a compassionate team that is working together to help them through the recovery process. Prevention is critical to damming the river that feeds the lake of addiction; only when all of us are working together will we be able to start emptying the lake and saving lives.