Home > Property & Casualty > Insurance industry looks to address opioid epidemic

Insurance industry looks to address opioid epidemic

opioidsThe opioid crisis is very present in the mainstream news these days. One can read the tragic stories of heroin addiction and the easy access to opiates, and the ensuing statistics are staggering. This is a truly an epidemic of our times.

Opioids have been the topic of conversation within the insurance industry for a long while now as well. Those within the medical claims industry have been aware of the severity of the opioid overdoses for some time, but there have been some recent events that have heightened the focus on this issue. The Massachusetts Department of Public Health’s preliminary statistics indicate that the number of deaths in the state directly linked to opioid overdose for 2015  is over 750, and is therefore  high enough for officials to regard the issue as a public health crisis. The state estimates that the number of deaths so far in 2015 appear to be higher than last year during the same time period.

One way the industry is approaching this issue is the existence of pharmacy benefit managers (PBMs) to help manage drug spending and allow employers to integrate claims and medication payment systems. Many PBMs have established early intervention programs and started to contact prescribing doctors to advise them on alternative drug regimens. A 2015 report published by WorkCompCentral claims that opioid use in workers’ compensation is subject to stronger controls and transparency in mid-2015 than in years past. The report also found that the medical community is more prudent in prescribing opioids without a follow up.

Carriers are beginning to develop various programs to address the opioid epidemic in regards to both patient safety and escalating claim costs. The intent of such programs is to alert claims professionals of suspicious prescription drug activities of patients, or other behavioral indicators that may reveal excess use in the present, or the potential for it in the future. Once confirmed that the claimant’s opioid use is cause for concern, these programs provide necessary medical supervision. The WorkCompCentral report called for more substantial investment in conservative care, including cognitive behavioral therapy and coaching, inter-disciplinary functional restoration programs, and work hardening programs.

The Insurance Regulators from various parts of the country are responding to this crisis. In late July 2015, the Massachusetts Division of Insurance, the Massachusetts Department of Public Health, and Massachusetts Department of Mental Health issued a Bulletin to provide guidance regarding access to treatment for substance use disorders on and after October 1, 2015, as required by MGL Chapter 258. This Bulletin demonstrates the presence and the severity of the need to access Acute Treatment Services, Clinical Stabilization Services, and Substance Use Disorder Services. Texas is another jurisdiction where steps are being taken to address the opioid issue. The Texas Department of Insurance Division of Workers Compensation recently advised the two opioids, Fentanyl transdermal patch and MS-Contin, will require pre-authorization beginning 2/1/16.

With the increasing severity of opioid usage, acute treatment, and escalating costs,  it is crucial for business owners to know their insurance coverages and to review and to reassess their needs. Please review your policies with your broker to ensure that your employees and your business are being taken of. Contact a member of Gallagher WGA to review your coverage, and to ensure you are properly covered.

About the Author

Ann_Mizner_McKay2Ann Mizner McKay is an Area Senior Vice President at Gallagher WGA and leader of the claims team. Ms. McKay has extensive experience and knowledge in various types of risks including technology, healthcare, business service, environmental, energy, life sciences, financial institutions, and other business risks.

617.646.0238 | Ann_MiznerMckay@ajg.com | Connect with Ann on LinkedIn

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