The Ohio Bureau of Worker’s Compensation has ordered the removal of OxyContin and its generic equivalents from it’s workers compensation formulary beginning June 1, 2019. Citing the high potential for “abuse, misuse, addiction and dependence,” the BWC will no longer authorize new prescritpions for the drug, and will require workers who are currently taking it to discontinue use and/or switch to a “safer alternative” by December 31.
The directive follows a 2018 study by the bureau’s pharmacy and therapeutics committee, which in 2016 recommended that physicians begin to scale back opioid prescribing for patients with chronic pain. The BWC will continue to authorize prescriptions for short-acting oxycodone (Percocet, Roxiprin) for acute pain.
A New, Better Opioid?
Although OxyContin will no longer be available, injured workers who require long-term opioids for control of chronic pain will not be left without alternatives, according to the Ohio BWC chief medical officer Dr. Terry Walsh. If their physician agrees, they may be switched to “an equally effective but harder to abuse” medication, Xtampza ER. One of several so-called abuse-deterrent opioids, Xtampza is, like OxyContin, a long-acting form of the opioid oxycode. But it is formulated in such a way that makes it harder to snort, smoke or inject — three common routes of abuse. However, its deterrent properties do not prevent patients from taking more pills than were actually prescribed — still the most common method of prescription opioid abuse.
How Safe Is Safe?
Whether abuse-deterrent opioids will have an effect on the rate of opioid-related deaths in the United States is unclear. According to Stat, there is little evidence that these new formulations have any effect on the rates of opioid abuse or opioid deaths. They are just as effective and, therefore, just as addictive as any other opioid. Their benefit is their lack of attractiveness to certain types of drug users — that is, those whose preferred method of administration is other than the oral route. The number on injured workers who fall into this category is unknow.
What’s more, abuse-deterrent opioids like Xtampza are far more expensive than generic opioids, a reality that may have the effect of substantially increasing the cost of Ohio’s workers compensation claims. According to several online sources, the best retail price for sixty 9 milligram Xtampza capsules is close to $300. An equivalent supply of OxyContin is about $130. More importantly, a 30-day supply of generic long-acting morphine with the same pain relieving properties is about $40 to $50.
As more and more governmental and regulatory agencies adopt policies mandating the use of abuse-deterrent opioids, this cost differential may have a chilling effect. As Stat points out, in 2016, the Department of Veterans Affairs spent nearly $100 million on prescription opioids for 1.2 million patients. Of these, only 1.9 percent were for abuse-deterrent opioids. But that small number of prescriptions accounted for nearly 40 percent of total opioid spending for the year.
How this will play out in Ohio remains to be seen. Certainly, workers compensation boards across the country will be eager to find out.
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