Opioids in Workers’ Compensation Medicare Set-Asides (Report to the Industry, published 10/17)


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An in-depth look at the prevalence and cost of prescription drugs included in Workers’ Compensation Medicare Set-Aside plans, with a focus on opioid analgesics.  Using data from 7,926 California Workers’ Compensation Medicare Set-Aside arrangements completed, submitted and approved by the Centers for Medicare and Medicaid Services in 2015 and 2016, the study finds that nearly 70 percent of these federally mandated and approved Medicare settlements for injured workers require funding for decades of opioid use, often at dangerously high levels and in conjunction with other high-risk drugs, even though such a requirement exceeds federal and state clinical guidelines and places patients at high levels of risk.  The report includes background information on WCMSAs, looks at average amounts submitted and approved for the plans, the distribution of the top 20 drug groups and prescription drug allocations in WCMSAs, compares WCMSA allocations for opioids to the utilization and cost of these drugs in a control sample of workers’ comp PD claims involving similar injuries,  and provides data on the strength, dosage and duration of the opioids included in WCMSA plans.