While policymakers from the local level on up to the Trump administration struggle to combat opioid abuse, employers are facing their own opioid-related challenge: skyrocketing recovery costs.
Workers covered through employer health insurance received $2.6 billion worth of treatment for opioid addiction and overdoses in 2016, an eight-fold increase from $273 million in 2004, according to a new report published by the Kaiser Family Foundation. Some $2.3 billion was covered by insurance, although patients doled out $335 million.
However, the study did find that while opioid abuse treatment has risen, actual opioid prescription use and spending among people with large employer coverage increased for several years before reaching a peak in 2009. Since then, both the use of and spending on prescription opioids within that particular population has tapered off.
Roughly $1.3 billion was spent in 2016 on outpatient treatment, according to Kaiser, with the average expense coming in at $4,700 and employees paying $670 of that bill. Some $911 million went toward inpatient care, which cost $16,100 on average. Workers were responsible for a little more than $1,600. Prescription drugs used for treatment cost $435 million.
Kaiser’s study is the latest to send warning bells to employers about opioid abuse, says Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions.
“Opioids are a huge issue that require all stakeholders, including employers, to do their part,” says Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions.
Employers have three key responsibilities, Thompson says, as they look to lowering some of these costs: Educate employees about opioid misuse, review their programs and policies to better align with the collective opioid agenda and engage with their health plans and PBMs to ensure they do their part.
When it comes to educating employees, Thompson says some issues to consider include proper storage and disposal of prescription medications, the dangers associated with sharing opioid medication with others, the need to ask questions of their providers if prescribed opioids as well as clarifying a clear path for how employees or their families can seek help and treatment if they are concerned about addiction or dependency.
Ryan Olmstead, director of member services for the nonprofit group Catalyst for Payment Reform, notes that historically, the data employers have received has been fairly limited, but they’re now demanding more from their health plan or a data warehouse vendor and diving deeper to understand the impact of drugs on their population.
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Because of this, employers and PBMs are beginning to make progress to reduce the risk of overdose, Olmstead adds. They’re reducing barriers to medication assisted treatment and limiting the opioid dosage prescribed to individuals.
Still, Kaiser’s figures include only payments for treatment covered at least in part by insurance, not services that are fully paid for out-of-pocket and not billed to insurance, so it’s likely the full cost of treatment is even higher.
“Programs and policies are being relooked at to ensure appropriate coverage and support, while better defining expectations for both supervisors and employees,” Thompson says. “Employers should set expectations for EAPs, health plans and prescription drug managers to play a more systematic role to identify potential opioid misuse and take actions to help address systemic issues and support employees and their families who have opioid issues.”
A recent benchmarking survey last year from the Midwest Business Group on Health found most employers indicating that they are changing their pharmacy benefit design by putting restrictions on opioid prescriptions, using prior authorization and quantity limits (as low as a 5-day supply) and more advanced utilization management rules, notes Cheryl Larson, president and CEO of MBGH.
Still, she cautions, “there is a fine balance between employers limiting access to opioids and providing alternative pain management options. Finding this balance is critical for employers and usually very challenging.”
In the meantime, people are seeking drugs elsewhere such as from friends and family, Larson says, echoing Thompson. “Until all stakeholders come together to address this complicated addiction, we anticipate a continued increase in spend for overdose and addiction treatment.”
