4 ways employers can combat prescription drug overuse and abuse
Sadly, just about any drug intended to address an acute condition can be overprescribed and abused.
The rise of prescription drug abuse is a rampant and well-documented problem affecting a wide range of age groups and many aspects of society. According to the National Center for Drug Abuse statistics, 16.3 million people misuse prescriptions each year, 12% of whom develop an addiction. The factors driving the rise of abuse are many, with experts attributing it to doctors writing more scripts than ever before and patients having greater access to more drugs via mail and online pharmacies.
While opioids, stimulants and central nervous system depressants are among the most common classes of prescription drugs likely to be abused, the list is not limited to those usual suspects. Drugs for skin tightening, erectile dysfunction, HIV PrEP, sleeping, anxiety, antibiotics and more are all ripe for abuse and misuse. Sadly, just about any drug intended to address an acute condition can be overprescribed and abused.
Related: Gaining the upper hand on pharmacy benefit fraud, waste and abuse
The overuse of prescription drugs is also detrimental to the workplace, contributing to rising health care costs and decreased employee productivity. Missed workdays and lost productivity from the misuse of prescription painkillers cost employers an estimated $25.6 billion a year.
HR leaders may feel powerless to stem these tides and reverse these sad trends, but they are not. It starts with taking a hard look at the company’s pharmacy benefits manager (PBM), securitizing their practices and policies, and demanding change.
1. Mind the auto-refill
One of the most common ways overuse begins is via the auto refill mechanisms offered by both retail and mail-in pharmacies. Auto refilling assumes employees are sticking to the drug adherence program religiously, which is usually not the case. The refill process is often triggered several days, if not weeks, before the most recent allotment of pills is due to run out, ensuring the PBM gets paid for processing and filling the prescription. Meanwhile, employees wind up with more medication than needed, leading to the potential for misuse by the employee themselves or someone in their family.
2. Audit discount card offerings
When an employee fills a prescription under an employer-sponsored plan, a record is produced that is shared among pharmacies, making it somewhat easier to spot prescription-filling overuse. However, when a discount drug card is used, the PBM essentially dissociates the responsibility for monitoring usage. The prescription is essentially being filled “off the grid.” HR leaders should understand what discount cards their PBM offers and how they can maintain visibility into their employees’ prescription drug usage, no matter whether they are filling scripts using the card or the company’s plan.
3. Edit the drug list
There are industries where medications of a particular type should simply never be used by an active employee. For example, airlines and the Federal Aviation Administration ensure that select drugs are never available for pilots, flight attendants and other critical employees. HR leaders should examine their employee populations and work more closely with their PBM to develop drug benefits packages appropriate for different groups of employees. Editing the list of available drugs not only puts safeguards in place for the workplace but can also contribute to guarding against the potential for prescription drug abuse.
4. Question the authorization rate
Finally, HR leaders should inquire about and familiarize themselves with their PBM’s approval rate for drugs that require prior authorization. While employees may get frustrated when confronted with the need to secure prior authorization, this process is designed to flag potential issues that could lead to overprescribing of a drug or present an opportunity to switch the employee to a different, potentially less problematic therapeutic option. If your PBM’s approval rate is in the 80% to 90% range, they are not carefully evaluating each prior authorization request but rather rubberstamping each claim, pocketing the higher rebate and ultimately contributing directly to the problem at hand.
While the picture of prescription drug misuse and dependence is not a pretty one, there are examples of employer action that others can take as inspiration. For example, the City of Hoboken and its team of 600 elected officials, located in a state where opioid abuse has run particularly rampant, worked directly with their PBM to reduce the average days’ supply of opioid prescriptions from 25.6 days to 20.3 days in just six months for its members.
By choosing to work with a PBM that holds itself to a higher standard of accountability, the City of Hoboken can count itself among those actively confronting this soaring problem. HR leaders can add their company names to this list as well.
Matt Gibbs is president of Capital Rx.
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