At the 2018 WCRI Annual Issues & Research Conference, Terrence Welsh MD, Chief Medical Officer for the Ohio Bureau of Workers’ Compensation discussed their efforts to decrease inappropriate opioid prescribing in Ohio.
Ohio has a monopolistic state fund, meaning if you are not self-insured you are insured by the state. Pharmacy management is done in-house. They average about 100,000 new claims a year. The injured worker has choice of medical provider in Ohio workers’ compensation.
In 2011, when Ohio BWC started reviewing this issue they had 8,000 injured workers dependent on opioids. Over 47,000 workers were receiving opioid medications, which was 73% of the injured worker population. There were 58 injured workers receiving over 1,000 mg of morphine equivalent doses.
By 2016, opioid dependent workers were down 50% to 4,100. The total percentage of workers receiving opioids also decreased sharply. In 2017, the number of opioid doses was down 28% from 2012. Their hope is these trends continue to decline. However, in spite of all of this their opioid deaths in the state have increased.
- 2010 Introduced MED monitoring into system.
- 2011 BWC implements closed pharmacy formulary.
- 2015 Provided coverage for naloxone products for opioid overdose recovery.
- 2016 Introduced opioid prescribing rule into Ohio Administrative Code.
Their closed formulary started with all medications covered over a three year period. Over time they established limits around certain medications including opioids. Opioid prescriptions were limited in both dosage and duration. They also allowed for treatment of opioid dependence without it being an “allowed” condition on the claim.
The formulary has resulted in 53% fewer injured workers receiving opioids. Their drug costs in the system are down 35% since 2011.
BWC is looking at ways to better educate both providers and patients on opioid medications and their impact. They are also looking at physician tiering models for reimbursement focused on the opioid prescribing patterns. They are doing advanced risk assessment profiling for patients. Finally, they are focusing on de-stigmatizing addiction and recovery efforts. Many employers do not want to drug test pre-hire because it limits their workforce too much but it is still important to identify people with addiction issue so they can receive proper treatment.