Tiffany McCaslin, NBGH senior
public policy analyst

A veteran of the pharmaceutical industry, McCaslin has been with NBGH for three years, helping to shape its policies for pharmaceuticals and, in particular, opioids. A recent NBGH survey revealed a high level of concern among its employer members for addressing the crisis, and NBGH has made addressing the crisis a top priority for this year and beyond. McCaslin discussed the government's response to stemming the crisis, and the work that remains to be done to truly reverse the tide of opioid addiction and related deaths.

BenefitsPro: In general, what is the business community's take on Congress's response to the crisis?

McCaslin: We are encouraged by the willingness of Congress to come together on this important issue. The biggest obstacle to Congressional action on the opioid epidemic has been the funding piece. This legislation makes a meaningful commitment to funding solutions, but many experts have observed that a substantially larger commitment needs to be made to advancing treatment for opioid abuse disorder. We also know that while government funding and government leadership is critical to addressing the crisis, a united effort by governments, the health care industry, employers and communities is needed to combat it.

BenefitsPro: How far short do you think that funding is?

McCaslin: It's difficult to give a specific number, but some experts have suggested it could be in the tens of billions. The House and Senate bills focus on increasing the availability of access to treatment. But that's just one part of the solution. We need to develop standards of care for the treatment of opioid addiction. We need to increase the availability of eligible providers and facilities. Employers are acutely focused on this issue, including as related to building plan designs and networks that will help employees receive needed treatment.

However, they often receive feedback that adequate resources are not available. This is particularly true for those residing in rural communities. To that extent, the appropriations process will be critical in how solutions are implemented. Further, as the legislation moves through conference, we urge Congress to keep out an earlier House provision, which was not included in the Senate draft, that would have changed Medicare coverage rules for end-stage renal disease (ESRD) patients. The provision is unrelated to opioid abuse and simply shifts costs to employer-provided health plans.

BenefitsPro: The crisis has been at the top of the news for three or four years now. There must be a list somewhere of approved treatment facilities, and a set of best practices for opioid addiction treatment models.

McCaslin: Unfortunately, we really don't have a list of effective models or centers for treatment. There is no widely accepted standard of evidence-based practices for treating opioid addiction. We are encouraged by the volume of work being done in this space, including by many stakeholders across the payer and patient communities, as well as within the medical community. We understand this is a space that is still evolving. Further, given the need for more specialists to treat in this field, we are also aware that many providers are practicing outside of their expertise in an effort to provided needed treatment services. With that in mind, standards of care are even more critically important.

BenefitsPro: Where are the largest gaps in our current understanding about how to treat this addiction?

McCaslin: Through our engagement with experts in this field, we have learned that the biggest gap is in understanding what makes an effective treatment protocol or facility. Although there are standards related to medication assisted therapy, there remains a lot of opportunity to further standardize care. Our partnership with the American Society of Addiction Medicine earlier this year revealed that, often, there is an attempt to adapt an effective model from addiction to addiction. But it's not that simple – there isn't a “one-size-fits-all” solution. That's where we are struggling from a plan design perspective. Coverage decisions are made based on medically endorsed and evidence based best practices. Absent those best practices, the potential exists for patients to receive the wrong treatment at a time when they may critically need it.

BenefitsPro: What is NBGH doing to address this gap?

McCaslin: We have been in contact with the [U.S.] Surgeon General's office and are encouraged by their efforts to develop those best practices. Organizationally, we are also working to expand our outreach to experts and stakeholders in this field, to better understand and flag additional opportunities for employers to improve access to quality treatment. Finally, we are learning all we can from our members about their experiences with the health care system, as related to treatment for opioid addiction. Clearly understanding the deficiencies is the best way to craft solutions.

BenefitsPro: Within the organization, what are some of your priorities for fighting addiction at work?

McCaslin: We have a number of initiatives underway to address our members' concerns. From a preventative standpoint, we are working with employers to rethink how pain, and chronic pain in particular, is treated. We have developed member resources on both non-opioid and non-pharmacological alternatives to pain management.

This year, we are also conducting an opioid summit: “Opioids on the Job: A Multi-part Series on Addressing a Crisis in the American Workforce,” which is a multi-part series aimed at addressing a multitude of employer questions and challenges on opioid related topics, some of which include: stigma, patient self-advocacy (i.e., requesting non-opioid pain management), and understanding how the reimbursement system can be modified to recognize the value of provider consult needed to rethink the tendency to prescribe an opioid when a an alternative may be more appropriate.

Read more about the impact of opioids on workers:

• Employers spend $2.6 billion annually on care for opioid addiction
• Opioid addiction knocking men out of U.S. workforce
• Mixed results in reduction of opioid use among injured workers