Alarming Rise in Opioid-Related Insurance Claims

(Fall 2016) Within a seven-year span (2007 to 2014), health insurance claims associated with heroin and opioid prescription painkiller dependence diagnosis exploded, increasing over 3,000%. The outbreak seems to be concentrated among a new demographic: middle-class Caucasians outside of urban areas, including individuals with private health insurance. Most of the claims were made by individuals aged 19 to 35, and men were more often found to be opioid-dependent than women.  Those diagnosed with opioid dependence used related treatment services, e.g., office visits and testing, 217,000 times in 2007 compared to seven million such instances in 2014

Research shows that the nation’s employers are unwittingly fueling the opioid problem to some degree. According to an analysis of almost one million medical and prescription claims, approximately 32% of opioid prescriptions issued through workplace-provided insurance are being abused. This number includes, but is not solely comprised of, medications received under workers’ compensation. Each worker who misuses these drugs drains an employer of close to $20,000 in health costs each year – almost double the price of a non-abuser. This estimate does not begin to touch on related workplace issues, such as productivity losses and safety concerns.

Insurance companies are working to find ways to curb some of the opioid problem. For example, The Travelers’ Company has created a model that pinpoints workplace injuries which often result in long-term pain and replaces opiates with a sports-medicine protocol. Data shows that this approach leads to a faster recovery with a smaller price tag, without the risk of opioid addiction.

Cigna is striving to aid with the crisis as well. The insurance company pledges to cut its customers’ usage of opioids by 25% within the next three years; assist with education, prevention and treatment efforts regarding these drugs; and is requesting that other health insurance firms unite with them by launching similar initiatives. Cigna has also donated sizable funds toward both addiction treatment and naloxone purchases.

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