February 23, 2017

Preventing opioid dependence

In October 2016, the Ohio Bureau of Workers’ Compensation (BWC) enacted a new rule that addresses and clarifies the prescribing guidelines for opioids, and creates financial consequences for prescribers who do not comply. The prescribing and use of these powerful pain medications have been high-profile topics for several years, and the state has taken action to try to control opioid prescriptions within the workers’ compensation system. Click here to read more about the new rule.

For many years, language has existed in the Ohio Administrative Code (OAC) that addresses opioid prescriptions, and provides recommendations for proper physical examinations and documentation, but they are presented as guidelines that stop short of mandating specific controls for physicians. A great deal is left to the treating physicians’ discretion. In the past six years, BWC has expanded upon the rules and guidelines by adding the following:

• In 2011, BWC introduced a medication formulary, or standard limitations on medications and dosages, and has continued to improve upon this model. From 2011 to 2016, opiate doses prescribed in workers’ compensation claims have decreased 48% and overall drug costs were down 46% over the same period. (Source: BWC Fiscal Year 2016 Report)

• In 2012, BWC focused on prescriptions from hospital emergency departments. Mandates included limiting supplies to three days, checking the OARRS (Ohio Automated Rx Reporting System) prior to dispensing, and requiring a referral to the individual’s primary care physician.

• In 2013, guidelines were expanded to address opioid prescriptions for chronic pain. The focus was placed on scrutinizing higher dosages, closer monitoring with a physical re-evaluation and additional OARRS checks every 12 weeks.

• In January 2016, guidelines were again expanded to address opioid prescriptions for acute pain outside of the emergency room. Physicians were encouraged to consider non-narcotic alternatives, limitations were placed on the number of pills per script, and OARRS checks were required for prescriptions greater than seven days.

The new OAC language added in October 2016 puts more teeth into the rule by defining the limits for BWC payments for these prescriptions, specifying that the guidelines above must be met. There are allowances for additional financial consequences when established prescribing guidelines are not followed. An emphasis is placed on consistent and thoughtful examination of the patient, independent exams and drug screens to monitor use, and careful evaluation of the actual effectiveness of the prescribed medications. The new rule also creates a mechanism for BWC to assist with opioid addiction treatment, including inpatient or outpatient detox and withdrawal medication.

CompManagement Health Systems (CHS) is deeply committed to providing oversight of prescription medications for clients’ injured employees. We routinely refer cases to BWC for Drug Utilization Review (DUR), and we have an outstanding track record of having the medications terminated or modified. We plan to continue to utilize our existing DUR process to address concerns related to prescriber compliance. Referrals for DURs can be made by any party to the claim and cases will continue to be referred for peer review to evaluate adherence to the prescribing guidelines.

If you have any questions on the new BWC rule or concerns about the medications involved with an active claim, please contact your CHS account executive.

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