Towns, states, and the entire country are struggling with the current opioid epidemic and how to address it. Some states and counties have created various initiatives to help reduce opioid abuse including dosage limits, expanded access to Narcan, and prescription drug monitoring program (PDMP) requirements. Ohio is one of those states tackling the opioid epidemic head-on, including their strides within the state’s workers’ comp system.
Over the last few years, Ohio has specifically targeted reducing the use and abuse of opioids among injured workers. The Bureau of Workers’ Compensation (BWC) implemented a series of targeted changes to their system and processes, resulting in significant decreases in the number of injured workers receiving opioids (51%) and the number of opioid dependent injured workers (50%).
Some of the key changes the BWC have implemented include the adoption of a closed formulary, dosage limitations, expanded access to medicines that treat opioid overdoses, and increased drug utilization review for many opioids. The BWC adopted a closed drug formulary in 2011, which has required prior authorization for some opioids. In connection with the formulary, the BWC has continued to expand the use of drug utilization reviews for opioids. This allowed the BWC to expand their review of the appropriate use of opioids even after the prior authorization phase.
One of the BWC’s biggest pushes to tackle the epidemic came in 2016 when they adopted opioid prescribing rules for workers’ comp claimants. The focus of the new rules was to incorporate best practices into the use of opioids for treating an injured worker, address opioid dependency arising from treatment including opioids, and implement systems to address non-compliance with best practices. Under the rules, physicians were required to follow the guidelines and best practices by the BWC tying reimbursement to the dose and duration limits. They restricted first fills for immediate release opioids to a 7 day or 30 dose supply, prohibited the concurrent use of immediate release opioids, and required prior authorization for any opioid script that included more than 6 doses a day. Additionally, physicians who deviated from the guidelines without prior authorization would be subjected to peer review by the BWC.
While Ohio has seen significant improvements, it is worth noting that Ohio’s workers’ comp system is different than almost all other states in the country. Ohio’s system is based around a state-funded monopolistic carrier, which means they have one workers’ comp insurer in the state. This has given the BWC greater control over prescribing patterns and approved medications than other states may have, but nonetheless, their programs have proven to be useful for their injured workers.