The use and abuse of narcotics in workers’ compensation has exploded over the past decade, creating skyrocketing costs, along with sharp increases in hospitalizations and death from overdose. Best practices to control opioid overutilization require systems to identify the issues in real time, educate the parties, and have a proven plan to implement steps that will improve the claim outcome.
The Human Costs of Drug Addition in Work Comp
Conservative estimates state that nearly 3 million Americans will become addicted to prescription drugs every year. The effects of addiction can often create devastating problems in personal relationships, employment difficulties, job loss, financial difficulties, legal issues, and psychological problems. Some of the mostly commonly abused prescription drugs include:
- Central nervous system (CNS) depressants and anti-anxiety agents. These are drugs used to treat psychological and psychiatric disorders;
- The most common use of these prescriptions are used to treat attention deficit hyperactivity disorder (ADHD); and work shift-induced sleep disorder.
- These are a classification of drug based from opium, which treat pain. Common opioid-based medication used by workers’ compensation claimants include morphine, oxycodone, hydrocodone.
Using MED Management to Fight Morphine Abuse
One innovative concept to battle morphine abuse in workers’ compensation claims is Express Scripts’ Morphine Equivalent Dose (MED) Management program. This unique idea has shown demonstrable results. As reported in the Express Scripts Drug Trend Report, the opioid utilization among injured workers decreased nearly 11% in 2014. It is also cutting costs in claim management programs and helping injured workers avoid problems related to prescription drug abuse.
What is MED Management?
The term MED is a calculation tool used to compare and contrast different pain medications to one another. These calculations “level the playing field” so to speak when comparing OR converting from one narcotic to another. MED Management is a clinical program to calculate the narcotic medication’s morphine-like potency, or MED, at the time it is being filled (before it has been dispensed). This helps reduce the chances an injured worker will become addicted to prescription pain medication, and can be particularly effective in preventing overdose in those claimant’s consuming 100mg or more of narcotic pain medications. According to the Washington State Agency Medical Director’s Group (AMDG), patients receiving 100mg or more per day of MED had a nine-fold increase in overdose risk.
Best practices in MED Management dictate a continuous review of an injured worker’s use of prescription drugs. When the prescription is presented at the pharmacy, there is an evaluation of the prescription medications a claimant is using. Certain standards are set that the individual is not allowed to exceed in a given period of time. If the individual exceeds the pre-authorized MED values, the prescription will not be filled, and will be submitted to the payer for review of appropriateness. The program also offers interested claim management stakeholders mechanisms to conduct ongoing utilization reviews of prescription drugs, which can also assist that person’s medical care management team to provide effective and efficient care.
The Benefits of MED Management
MED Management has countless benefits that provide a “win” for all interested stakeholders in a workers’ compensation claim:
- Injured workers: They continue to receive the medical care and treatment they are entitled to under any workers’ compensation program. They also receive attention to their needs and assistance in avoiding prescription drug addiction and overdose.
- Insurance Carriers and Self-Insureds: Parties who use this system receive the benefit of a proven program that reduces cost and future exposure.
- Claim Management Teams: Having an ally in managing a workers’ compensation claim is important. This program provides expertise in a complicated area of the claims process.
Conclusions
The MED Management program can be an effective tool in the effective management of a workers’ compensation claim. It also allows all parties to receive the benefit of a proven program by reducing the chances of the injured worker from becoming another statistic in the prescription drug epidemic.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: [email protected].
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