To control skyrocketing costs and help deal with the statewide problem of rampant prescription drug abuse, the Ohio Bureau of Workers’ Compensation has stepped up monitoring of the millions of doses of pain pills given injured workers each year.
Starting this month, BWC won’t cover controlled substance prescriptions for chronic care unless the provider enrolls in the the Ohio Automated Rx Reporting System (OARRS), which tracks prescriptions for possible misuse. The rules are the latest in an effort to better track opiate use by injured workers.
The Bureau of Workers’ Compensation is a state-run insurance program for injured workers. Over the past five years, it has paid for more than 188.5 million doses of narcotics prescribed to injured workers.
For years, BWC did little to track who was using what prescription drugs, at what levels and why. But starting in 2011, the bureau took steps to monitor and reduce prescriptions of overused drugs: instituting a drug formulary, 120-day limits on opioids and muscle relaxants within a 12-month window, prior authorization requirement for some drugs, and a requirement that prescribers use the automated reporting system.
BWC Pharmacy Director John Hanna acknowledges that changes are long overdue.
“Very much like other insurers or workers’ comp carriers, we had not paid a lot of attention to our drug utilization prior that time,” Hanna said. “That’s why you see some of the dramatic changes. All we’ve done is introduce tools and introduce policies that should have been in place all along. So, we are playing catch up in a lot of aspects.”
In 2013 BWC spent $38.2 million a year on narcotics — about one-third of its $115.8 million pharmacy budget — for 357,970 opioid prescriptions to 39,028 claimants.
The average narcotic dosages per injured worker climbed from 599 in 2001 to a peak of 828 in 2010 before beginning to taper to 788 in 2013. Between 70- and 74-percent of injured workers are prescribed opiates.
Hanna said there is a lot of blame to go around for the pill addiction crisis in Ohio.
“I don’t think we contributed any more than any other commercial or state agency,” he said. “Everyone pretty much missed the ball on the changes to our prescribers’ approach to using these drugs, society’s expectations on the use of these drugs. What you’re seeing here is, in reality, no different than what happened with antibiotics back in the 1940s, or steroids in the 1950s and 1960s or estrogen products in the 1970s and ’80s,” Hanna said. “They were over prescribed and over utilized and consequently there were public health implications from that misuse of the drug. We see it with opiates.”
BWC now tracks the opiate load of every injured worker for every month and is starting to track anti-anxiety drugs in the same fashion since high doses of those two classes of drugs can be deadly. Ohio may be the only state workers’ compensation system to do such tracking, Hanna said.
Claimants taking 60 milligrams per day or more of an opiate are considered by BWC to be physically dependent on the drugs, Hanna said.
In late 2011, 8,096 claimants were on 60 mg per day or more, including 59 who were prescribed 1,000 mg per day or more. (Sixty milligrams equates to 12 Vicodin pills every day, he said.)
The number of workers on such high doses is decreasing, according to Hanna. Currently, BWC has 6,512 injured workers on 60 mg per day or more with 29 on 1,000 mg or more. The person at the top of the list is prescribed 4,000 mg per day for a bad back, he said.
BWC pays for drug treatment for injured workers if the addiction is allowed for under their claim. Hanna did not have statistics on how many injured workers fall into this category.
Opiate prescriptions have dropped 27.8 percent and muscle relaxant prescriptions have declined 72.9 percent in 2013 compared with 2010.
“I see our trend lines continuing to decrease because we are going to further to refine our coverage of the opiates,” Hanna said.