National Business Group on Health recommends employers discuss opioid use for pain management with health plans, PBMs

Calling the misuse and abuse of opioids a national issue that profoundly impacts employees, their families and employers, the National Business Group on Health, a non-profit association of more than 420 large U.S. employers, is recommending employers work with their health plans and pharmacy benefits managers (PBMs) to assure they are implementing national guidelines for prescribing opioids.

The Centers for Disease Control released “Guidelines for Opioids for Chronic Pain” more than two years ago. The guidelines provide clear recommendations for prescribing opioids and managing patients using them for chronic pain. The guidelines cover recommendations for dosage, duration and follow up, as well as recommendations to assess risks and harms. Despite the guidelines and evidence from clinical research, overprescribing remains a top concern. Similar concerns exist about prescribing opioids for management of acute pain as well.

“Inappropriate use and abuse of prescription opioids is rapidly becoming a major issue for employers across the country,” said Brian Marcotte, President and CEO of the National Business Group on Health. “In addition to the devastation it causes employees and their families, research shows opioid misuse costs employers billions of dollars from absenteeism and presenteeism alone, affects hiring and retention, and negatively impacts worker productivity, workers compensation claims and overall medical costs. While health plans and PBMs have initiated various opioid management programs, opportunities remain to implement the CDC guidelines and we recommend employers work with their vendor partners to review the guidelines and take action to fill any gaps.”

Specifically, the National Business Group on Health is recommending employers actively engage in conversations with the health plans and PBMs they work with and ask if their efforts and their work with clinicians include the following:

  • Strategies to mitigate risk of addiction before starting and periodically when continuing opioid therapy;
  • Limits on opioid prescriptions for acute pain to short durations. Three days or less will often be sufficient;
  • Use of immediate-release opioids when starting therapy for chronic pain instead of extended release/long-acting opioids;
  • Use of the lowest effective dose when prescribing opioids; and,
  • Avoidance of concurrent prescribing of opioids and benzodiazepines whenever possible.

Importantly, a recent National Business Group on Health survey of 62 large employers found 60% experienced at least one issue arising from prescription opioid drug misuse or abuse in the workplace. Some of the most common issues that occurred were increased medical or pharmacy costs for chronic opioid users (40%), increased absenteeism or missed work among chronic opioid users (40%) and employees overdosing on prescription opioids (18%).

“Given the widespread nature and expanding scope of the opioid crisis, it is encouraging to see employers are taking steps to help prevent its spread and assist employees and their families who may be affected. Employers have begun to ramp up efforts to increase employee awareness of the issue, prevent misuse, and help those needing treatment. These efforts include plan design changes, education, communication and training for managers and employees, and working with health plan partners,” said Marcotte.

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