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Using Your Health Plan to Fight Opioid Addiction.

Most government finance officers are well aware of the opioid abuse problem facing the United States. When the drug is prescribed legally for pain relief, the costs are typically covered by a health plan. Most health plans also cover the treatment or counseling an employee seeks when facing addiction. It makes sense to look at the organization's health plan to determine whether any part of it might be inadvertently contributing to the opioid addiction problem, according to "Opioid Abuse in America: Can Your Employer Health Plan Be Part of the Solution?" an article by Ogletree Deakins, a leading labor and employment law firm.

Many employers offer an employee assistance program that provides counseling for addiction and support for employees with family members who suffer from addiction. These programs are extremely important, but employers also need to make sure they "remove any real or perceived barriers that may keep employees or their family members from seeking treatment. The article asks, "Do employees know help is available? Are they assured the treatment will be confidential? Is there a stigma attached to participating?"

In fact, many plans include features that can discourage employees from seeking treatment, sometimes in the form of features designed to manage claims and curb abuse. "For example, some plans require a patient to first seek outpatient treatment before an inpatient service will be preauthorized," the article notes.

Requiring prior authorization before admitting the patient to an inpatient facility can also pose a roadblock that might stop an addict from getting treatment.

Speaking of which, are substance abuse treatment facilities readily available where employees live and work, and are they part of the plan network? If access is an issue, "telemedicine offers another option for employees who are reluctant to walk into a counselor's office or group therapy," according to the article.

Including coverage for alternative therapies might help decrease opioid use. "For example, many patients suffering from chronic pain seek relief through acupuncture, massage therapy, physical therapy, occupational therapy, chiropractic treatment, or soft-tissue mobilization techniques. Providing comprehensive coverage of these therapies may help reduce opioid dependence," the article suggests.

It's ideal to address the issue before the addiction begins, and one way to do that is to have a case manager or pharmacy benefit manager who can intervene before an individual's first prescription for opioids is filled. The case manager can offer to "work with the doctor, pharmacists, and patient to make sure the patient understands the prescription is for an opioid and to determine whether a non-addictive option is available. Efforts to coordinate care among the individual's various medical providers can reduce costs, eliminate duplicative or excessive prescriptions, and improve patient outcomes."

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Publication:Government Finance Review
Date:Jun 1, 2019
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