The Two Legal Moves Rhode Island Carriers, TPAs, and Employers Should Consider to Protect Employees’ Health...and The Bottom Line.
Keith A. Cardoza, Jr
The nationwide opiate crisis is no secret. One can’t turn on the radio or television, open a newspaper, or browse the web without confronting another overdose tragedy or proposed legislative solution. Rhode Island is in the thick of the crisis.
And, unfortunately, that crisis brings both obvious and hidden costs. Thus, a study published in the Journal of Occupational and Environmental Medicine found that when opiate painkillers are prescribed in workers’ compensation claims, the employer costs soar exponentially. Similarly, opiate abuse by employees nearly doubles an employer’s annual per employee medical expense, according to a study last year by Castlight Health. Add to such costs the expense of absenteeism, low productivity, and dangerous conditions created by an addicted employee, and addressing potential opiate abuse becomes more than a theoretical societal problem. It becomes a fiscal imperative.
But how do carriers, TPAs, and employers address that imperative? By capitalizing on new legislative tools designed to stem the opiate abuse crisis caused in part by overprescribing physicians and poorly-educated patients.
The Problem and The Regulatory Solutions
According to the National Safety Council, a March 2016 physician survey revealed that 99 percent of doctors routinely prescribe opioids well beyond the recommended initial 3-day limit, and nearly three-quarters of the physicians surveyed didn’t know that ibuprofen and acetaminophen offer more effective pain relief than morphine and oxycodone.
Fortunately, Rhode Island has joined many states in providing legislative intervention. As most of our clients know, a Rhode Island employer is required to provide payment for an injured employee’s prescription medication for such a period as is necessary to cure, rehabilitate, or relieve the employee from effects of an accepted work injury. The prescribed medication must be accepted by doctors at the national level in order to be reasonable and thus compensable. Pola v. Health-Tex, Inc., 605 A.2d 1321 (R.I. 1992).
In 2014, the Rhode Island Legislature established the Prescription Drug Monitoring Program (PDMP) in response to the growing opiate abuse epidemic. The PDMP is an online database that compiles a patient’s controlled-substance prescription drug history. Prescribing doctors log into the online database and view a patient’s prescription drug history from 2014 forward, allowing physicians to identify addictive behavior as well as avoid potentially harmful drug interactions. While participation in the PDMP was initially voluntary, statutory provisions are now in effect that require medical providers to be registered with the PDMP as well as to check the PDMP’s electronic database before prescribing an opioid prescription for the first time to a patient. These laws further require a medical provider to check the PDMP’s electronic database every three months while prescribing opioids. (RIGL § 21-28-3.20).
Our Two Recommendations for Carriers, TPAs, and Employers
First: Discover PDMP Data
In appropriate cases, we recommend requesting your counsel issue subpoenas to the PDMP to obtain an injured worker’s prescription records and ensure these records corroborate the treatment history alleged. Doing so could avert potential opioid abuse and unnecessary costs.
Second: The Three-Month Check-In
In addition, we recommend seeking clarification from prescribing physicians on a three-month basis to confirm compliance with the regulatory requirements mentioned above. As discussed, prescription medication alone is costly for employers, carriers, and self-insureds alike. When that prescription medication is abused, the expense becomes exponential. Thus, it is crucial we ensure medical providers are complying with the applicable regulations.
Questions? Contact Keith Cardoza, Ron Izzo, or Bill Gardner.