At the IAIABC Annual Convention, Nicholas Trego, Clinical Operations Manager with the Ohio Bureau of Worker’s Compensation discussed their strategies to reduce inappropriate opioid consumption on claims. The State of Ohio is the monopolistic workers’ compensation carrier.
The program started in 2014 when they gained access to the Ohio PDMP. This allowed them to access the state database showing all opioid prescriptions that an injured worker was receiving. In 2015 they implemented coverage for nalozone products as part of opioid overdose prevention.
Ohio developed a closed drug formula that focused on several things, including whether the medication is causally related to the claim. If a physician prescribes an approved medication for a related condition, this does not require prior authorization. The closed formulary started with all drugs that had been prescribed on workers’ compensation claims in the last three years. This is continually modified as needed. It is truly a closed formula as coverage is denied if the drug is not on the formulary. There is clinical oversight of the formulary with a Pharmacy and Therapeutics Committee, which consists of six physicians and six pharmacists. Their goal is to ensure they are following best practices prescribing guidelines.
In 2016, the state passed opioid prescribing rules for workers’ compensation that included mandatory drug testing, formal review by a clinical nursing staff, patient education around opioid use, and also treatment for opioid dependence without it being an allowed condition on a claim. In other words, if a patient wants to go through a detox program, they can do that without it adding a condition to the claim.
The formulary limits initial prescriptions to 7 days or 30 doses. They also stopped concurrent use of immediate release opioids because that was viewed as duplicative treatment. Their formulary also limits prescriptions to 6 doses per day. Low morphine equivalent dose opioids must be tried before moving on to higher doses. They also stopped concurrent use of injectable opioids (morphine pumps) and oral medication. They are also limiting quantity limits based on approved FDA dosing guidelines.
Under the formulary, the percentage of workers on opioids dropped 14%. This has dropped steadily since the inception of the formulary. Currently 62% of their claims involve opioid claims. They hope to get that number down to 50%.
In 2012, 33% of all injured workers with new claims continued opioid use longer than 84 days. In 2016, this was down to 21%. Since 2012, the rate of new claims that receive opioids is dropping steadily.
The outcomes of their program include total drug spend down over $48 million and total opioid doses down 19.5 million compared to 2011. Their turnaround times (when authorization is required) is under 2 hours.