Can employers protect their workers from opioid addiction? New Jersey's city of Hoboken is doing its best to try, and betting on holistic
Opioid addiction has impacted three million people in the U.S., and opioids were involved in nearly 70,000 overdoses in 2020 alone, according to the CDC. While many employers may feel helpless in the face of a substance abuse crisis, Hoboken has partnered with pharmacy benefits manager Capital Rx to take proactive steps to reduce its employees' dependence on opioids.
"We haven't had to deal with [opioid addiction] very seriously as of now, but we're not immune to it as a community," says Jason Freeman, business administrator with the city. "So when we first started working with Capital Rx, one of the conversations we had was about how we can be ahead of the game rather than trying to react after the fact."
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Capital Rx defines itself as a transparent PBM, providing data on medications members are using while maintaining compliance with applicable privacy laws. Additionally, the PBM establishes different levels of pain management solutions rather than jumping to opioids as the first choice.
"We ensure that the appropriate prescriptions are being provided prior to the escalation of therapy, which would be long-term opioid use," says Anthony Cairo, senior clinical account manager at Capital Rx. "Then we work with retail pharmacists in the community who can check statewide databases and see whether employees are filling prescriptions without their insurance and just paying cash or doctor shopping."
"Doctor shopping" is when patients see multiple healthcare providers to obtain a drug without the prescribers' knowledge of duplicate prescriptions. Freeman notes that in his previous relationships with PBMs, they didn't even share which prescriptions were being used by Hoboken's workforce for budget-planning purposes, let alone how their employees interact with the healthcare system.
"Every year the city was trying to put together a budget for what our total insurance program was going to look like," he says. "But we had no idea what issues employees were having because it was essentially a black box with that PBM. It was a complete lack of transparency."
When the City of Hoboken became self-insured, Freeman knew they couldn't afford a one-sided relationship with their PBM and risk losing money for not only their workers but for taxpayers. And while the U.S. healthcare system isn't known for its transparency or clarity, Freeman emphasizes that he at least wanted to understand what his workforce was facing.
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"In a previous experience, we would never even know if a member was prescribed an opioid," he says. "With Capital Rx and the monthly meetings that we have with our self-insurance fund, we go through every single drug."
Cairo encourages employers to seek a collaborative relationship with their PBMs, and notes that by leaving themselves in the dark, employers could be putting their employees' well-being at risk.
"We partner with our clients by establishing transparency — that best positions us to then establish safety and efficacy," says Cairo.
Freeman admits that the current healthcare system doesn't always make it easy to avoid opioid misuse. According to the Minnesota Department of Health, the U.S. consumes over 80% of the world's opioids, with opioid prescriptions among the highest in the world.
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"The entire healthcare field is ultimately a business," says Freeman. "Doctors are put in a situation where they need to find the quickest route to pain management in order to maintain their business. And that lends itself to over-prescribing and too quickly prescribing an opioid when the situation may not require one."
But Freeman only feels more determined to give his workforce holistic and responsible pharmaceutical care.
"We want to make sure that we're offering the best services to our employees," he says. " Being an employer of choice is not just about employees getting gratification from coming to work every day, but employees knowing that they're getting taken care of."
