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Link Between Opioid Use And Workers’ Compensation Claim Costs


If you are ever injured at work, it’s good to know that workers’ compensation will be there when you need it. With the operating ratio below 100 percent for the past three years, this type of insurance has been profitable.

Workers’ compensation is not without its issues, however. Rising health care costs, economic instability and the use of opioids for pain management are causing state workers’ compensation boards to spend more and more money on workplace injuries. Claims that involve opioids tend to stay open longer than those without opioids. Opioids also tend to lead to addiction, which is why administrators are looking for alternative methods to relieve pain.

Understanding Opioid Dependence

Not many people expect to become addicted to pain medication, but it is actually very common. Opioids are commonly used for pain relief, and while they are very effective, they are also highly addictive. They are also more expensive and can become costly with long-term use. This affects not only the patient, but also his or her family, health care providers, the insurance company and the employer.

Between 2012 and 2015, total prescription spending for workers’ compensation claims increased from $42 to $70. When opioids were prescribed, the dollar values were much higher. They rose from $366 to $475 during that same time period. This is a difference of more than $400 in some cases. This cost adds up quickly when you take into consideration that there are approximately 3 million workers’ compensation cases per year in the United States.

To curb opioid use, many states have regulations in place. This has helped reduce claim costs and also prevent unwanted effects, such as opioid dependence and costs for rehabilitation. For example, some states have drug formularies in place to prevent overdosing. Others require health care provider education and training. Some have legislative actions in place.

But are these actions helping at all? The workers’ compensation industry is monitoring the claims that come in and using established protocols to reduce the risk of opioid addiction. It is requiring teamwork on the part of employers, insurance companies, health care providers and each state to reduce costs while improving claim outcomes. The good news is that prescription drug costs involving opioids decreased 5 percent between 2012 and 2016.

Pharmacy management programs have also been introduced to help reduce costs. These programs include a pharmacy and provider network with education, safety alerts, star ratings, best practices and other features to help mitigate prescription drug costs.

Contact Us for More Information About Workers’ Compensation Benefits

 State workers’ compensation boards are cutting down on unnecessary costs, which means that you may not get the medication you need or you may get your claim denied altogether.  If you were injured in the workplace, it’s important that you get the medical care you need so you can return to work quickly.

Contact the Law Office of Michael Lawrence Varon in White Plains for help with your case. He can help you understand the process and explain your options.  Call 914-294-2145 to schedule a consultation.



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