KEMI Keeping Close Watch on Prescribed Narcotics to Injured Workers in Kentucky
Lexington, KY (WorkersCompensation.com) - Kentucky Employers’ Mutual Insurance (KEMI) has been working diligently for several years to protect injured workers from prescription drug addiction, a problem which has now reached epidemic proportions according to local, state, and federal experts.
Based on a research brief prepared by the National Council on Compensation Insurance (NCCI), all prescription drug costs (including narcotics), among workers’ compensation carriers nationwide, account for approximately 20% of the total medical cost of lost-time claims in the workers’ compensation insurance industry.
In KEMI’s experience, however, that percentage was substantially lower – just under 16% in 2011 – largely due to the scope and effectiveness of claims management efforts employed by KEMI. Since 2005 KEMI’s prescription drug costs have averaged at 13.5% of the total medical cost, well below the national average as reported by NCCI.
As Kentucky’s largest provider of workers’ compensation insurance with more than 21,000 policyholders throughout the state KEMI continues to find itself on the front lines of the battle against opioid addiction with each new claim filed for an injured worker.
KEMI began monitoring prescription drug usage more than a decade ago by implementing a comprehensive Pharmacy Benefit Management (PBM) Program which sought to protect injured workers from excessive drug usage and potentially dangerous drug-to-drug interactions.
Upon implementation, the PBM Program provided an instantly-effective solution to monitor prescription drug trends and ensure that injured workers were receiving the highest standards of care available throughout the lifecycle of their claim. KEMI’s PBM Program also looked for other early warning signs such as whether the injured worker attempted to refill medications too soon, visited multiple doctors to obtain prescriptions, or acquired prescriptions from a physician outside the approved managed care network.
In 2003, KEMI stepped up its efforts to monitor the prescribing of OxyContin and other narcotics in light of the sudden and dramatic increase in the utilization of these drugs to treat injured workers. In addition to establishing pre-authorization requirements for the medications most often abused, KEMI increased its communications with physicians and utilized the data supplied by the PBM to ensure the safest and most appropriate care for injured workers.
“Based on the data we have gathered over the last decade, we are confident that PBM Programs such as the one implemented by KEMI can have a measurable impact on claims outcomes when closely monitored,” said Kim Justice, Claims Director for KEMI.
“The PBM Program added an additional layer of protection for the injured worker that far surpassed what one person or even a team of people could detect, but it also helped KEMI establish benchmarks in evaluating prescription drug costs relating to medical care for injured workers.”
While the KEMI PBM Program has reduced prescription drug costs and has helped streamline the organization’s claims management process, the most rewarding benefit can be found when considering the thousands of injured workers who have been protected from potentially habit-forming drug usage.
“We recognized early on that the drug problem was only going to get worse, not with just one industry, but all throughout Kentucky,” said Roger Fries, President & Chief Executive Officer of KEMI.
“We have a responsibility to help protect our policyholders and injured workers from the dangers that come with using opioids to treat pain. The problem in workers’ compensation claims is not only a direct result of doctors whose approach to medical care is both ineffective and harmful, but indirectly through pill mills and drug pipelines.”
According to Kentucky Attorney General Jack Conway, the prescription drug problem represents as much as $200 billion in health care costs each year, and statistics from the National Centers for Disease Control and Prevention indicate that abuse is taking the lives of almost 1,000 Kentuckians annually.
Recent data shows that more than 1,500 coal miners tested positive for drug use since Kentucky began screening six years ago. Mike Haines, who oversees the Office of Mine Safety and Licensing’s screening program, said that most of the miners testing positive have been abusing prescription painkillers.
“Addiction is a very real and present danger for injured workers who receive prescriptions for heavy painkillers,” said Mr. Fries. “Like most insurance carriers, KEMI emphasizes work place safety in traditional areas such as slips, trips, falls and lifting. However, loss education efforts are ineffective and lives will continue to be endangered until the prescription drug issue is addressed.”