Ballooning prescription and medical care costs and the opioid crisis have contributed to more conversations regarding practices in the area of Workers’ Compensation. The upcoming year is likely to see some changes in how industry handles injured employees, their care and workers’ comp claims.
Hot topics for 2020 include managed care for the injured, drug formularies and prescription limits for opioids.
Directed managed care
For injured employees being treated under workers’ comp plans, managed care has often meant being assigned to a physician under a single plan with whom the employer contracts, a system that has sometimes resulted in inconsistent care and a too-soon return to work. In recent years, however, managed care policies have evolved to carefully constructed treatments, including prescribed medications, which have resulted in improved care, reduced costs and better results for the injured.
Look for more states to begin adopting directed managed care plans to improve outcomes of claims, reduce fraud and ensure medications are prescribed under specific treatment guidelines.
Drug formularies
In conjunction with managed care guidelines, drug formularies provide rules for physicians that direct appropriate drugs for certain injuries and conditions, and appropriate fees for those prescriptions and dosages. The guidelines provide time frames and dosage limits, as well as specifics on dangerous drug interactions, thereby increasing safety and reducing costs.
Look for states to turn more frequently to drug formularies as a way to control ballooning drug costs, get more timely care for injured workers, and address the opioid crisis. For states already using drug formularies, statistics show a significant reduction of injured workers receiving non-approved drugs and drug prescriptions, and decreases in drug costs for both opioid and non-opioid drugs.
The opioid crisis
The growing crisis of opioid addiction and overdose deaths has created urgency for workers’ comp providers and physicians in general to better understand the types of treatments that can best serve workers hurt on the job. Look for an increase in the use of drug formularies to limit strength and amount of prescription drugs as well as the number of prescriptions, as these efforts continue to have a positive impact on the opioid epidemic.
Statistics show already the number of opioid prescriptions has dropped significantly in the last year, and at the state level more than 90 bills are currently before state legislatures seeking to control dosages and prescriptions.
At the federal level, watch in 2020 for movement on the John McCain Opioid Addiction and Prevention Act, which would amend the Controlled Substances Act to require that a practitioner agree to limit the supply of opioids prescribed for the initial treatment of acute pain as a condition of obtaining or renewing a registration through the Drug Enforcement Administration.
If you have been injured and have questions about your rights under workers’ compensation, contact Attorney Todd A. Bergert, or click here for more information on how he can help you with your claim.