Editor’s Note: This is part of a team report on opioid use by injured workers. For the national story read: Opioid Epidemic Plagues Workers’ Comp
In the South Central region, Texas and Oklahoma are two states where the battle against opioid abuse among injured workers is being taken up by lawmakers.
Both states have seen new bills introduced to curb abuse by raising standards for use of evidence-based medicine, and stricter regulation of drug dispensing doctors and clinics.
Oklahoma in March 2012 enacted legislation adopting the Work Loss Data Institute’s Official Disability Guidelines (ODG) as the standard for evidence-based medicine in determining scope and duration of medical treatment in workers’ compensation.
Senate Bill 878 left the door open for the state’s Physician Advisory Committee to draft additional guidelines that may be considered for use on procedures that are not covered by ODG, according to an announcement from the Institute.
This year, Oklahoma’s legislature successfully passed a comprehensive workers’ comp reform bill, Senate Bill 1062, which was signed by Gov. Mary Fallin. While much of the discussion about the legislation focused on the fact that it transforms the system from a court-based system to an administrative one, and creates an alternative insurance option for employers, the bill also addresses the problem of controlled substances.
It calls for the adoption of guidelines to be drafted by the Physician Advisory Committee “for the prescription and dispensing of any controlled substance included in Schedule II of the Uniform Controlled Dangerous Substances Act” if those substances are not addressed in the current edition of the ODG.
The bill also limits reimbursement to physicians who dispense prescription drugs to “no more than ten percent (10%) above cost.”
Texas has been working on improvements to its workers’ comp system for more than a decade and by most accounts, the system is working very well.
The state recently passed a “pill mill” law to better regulate pain management clinics, and it introduced a close formulary on perscription drugs in the workers’ comp system. Early studies suggest it may reduce the utilization of Schedule II narcotics.
The total cost of opioid use in the Texas workers’ compensation system began decreasing in 2007 for both lost time claims and medical-only claims, according to a report issued by the Texas Department of Insurance-Division of Workers’ Compensation, “Healthcare Cost and Utilization, 2012.”
For lost time claims, the cost to the system for opioids fell from a high of more than $40 million in 2007 to just under $35 million in 2011. For medical only claims, the cost for opioids in 2011 was slightly higher than $3 million, down from more than $6 million in 2007.
While central nervous system (CNS) drugs have the highest average cost per claim, opioid groups currently are the most costly to the system in terms of total cost, the study found.
The DWC classified the opioid drug group into five subclasses to analyze trends in utilization and costs within the group. Among these subclasses, “the ‘opioid agents’ subclass accounted for about 60 per cent of total opioid drug costs, followed by the ‘hydrocodone combinations’ subclass,” the report said.
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