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Is Your Workplace Prepared For The Opioid Epidemic?

by AHIP

May 30, 2018

Friends, families, colleagues—these are who’s being hurt by opioid addiction. Drug overdoses are now the leading cause of death for Americans under 50 years of age, with 142 Americans dying every day from an opioid overdose.

Health insurance providers are committed to finding solutions to help unravel and solve the nation’s multi-faceted opioid crisis. This means working with employers, who can help prevent opioid addiction and misuse in the workforce.

Scope of the Problem and Cost to Employers

  • About 4 in 10 opioid addicts are covered by large employer health plans
  • The cost of treatment for opioid addiction was $2.6 billion in 2016
  • The average employer spends $19,000 per year, per employee for treatment related to opioid addiction

What Employers Can Do

  • Reduce the stigma around drug addiction and mental health treatment
  • Train managers to identify warning signs and understand how to approach employees who exhibit signs of distress or addiction
  • Explore options for tele-mental health care

How Health Insurance Providers Can Work with Employers

  • Implement or expand and promote an Employee Assistance Program (EAP). Ensure that a chosen EAP vendor has substantial experience with drug counseling and substance abuse treatment referrals
  • Implement utilization management, such as step therapies, quantity limits require prior authorizations for opioid prescription fills beyond the CDC recommended seven-day period
  • Work with a  pharmacy benefit manager (PBM) or partner with the health plan to monitor the use of prescription drug usage
  • Ask the plan to use data to identify whether particular geographic regions or employee groups have higher levels of opioid medication fills. Plans can also identify whether an employee population shows above-average levels of medical conditions (such as back pain) or behavioral health conditions (such as depression) that often lead to a higher likelihood of opioid abuse
  • Identify gaps in network adequacy and work with a health plan to address shortages of mental health or treatment facilities that are in-network. This is especially important in rural areas
  • Implement drug “lock-ins” for high opioid users that require enrollees to use a single pharmacy or a single medical provider for opioid prescriptions, which can help reduce doctor shopping
  • Have social workers available to members who may be able to continue to work with those in addiction treatment to address ongoing needs and social determinants

To learn more about health plan strategies for tackling the opioid crisis, please check out AHIP’s Safe, Transparent Opioid Prescribing (STOP) Initiative.