Where to look

Addressing Pain Management & Opioid Use/Abuse

Getting & Using Data: Where to Look

Be sure to look at both internal and external data sources so you have a complete picture of the impact opioids could have on your organization. Following are key places to start. More information on What to Look For can be found in the next section.

Pharmacy Benefits Manager (PBM) & Health Plan

The aggregate data you get from your PBM and health plan will form the basis of your business case for addressing opioid abuse and launching related initiatives for improving pain management strategies in your organization.

  • Your PBM can provide important data about the prescription drugs that are dispensed through both mail service and retail pharmacies. However, this does not provide a complete picture. Forty to fifty percent of all drug claims are not processed through the PBM.11
  • Your health plan may have data on some drug claims for opioids that don’t pass through the PBM because they are doctor dispensed and covered by the health plan. This is a small but key piece of the data puzzle. It’s important for employers to take note of larger than anticipated quantities of opioids being dispensed by practitioners.12
  • Ensure that your health plan provides data on health care utilization related to pain diagnoses and opioid abuse, dependence or poisoning. This includes inpatient, outpatient, urgent care and use of the emergency room.


Short- and long-term disability

Compare your organization’s disability data to your industry peers by looking at national benchmarks (publicly available or through your vendor) by industry type and clinical condition. For some industries the benchmarks may vary by quarter based on the sample size of the benchmark. In these cases, it may be beneficial to review benchmarks for “all industries” rather than by a specific industry.1

Workers’ Compensation

Many claims for workers’ compensation include employees being treated for pain as a result of an acute injury. This data is segmented from health and pharmacy claims.1

Other Sources of Data

  • Employee Assistance Program (EAP): Request aggregate encounter data on use of the EAP for prescription drug addiction
  • Safety reports of accidents: Look for information about prescriptions for pain medication
  • Health Risk Assessments (HRA): If you already use an HRA with your employee population, consider adding a few questions to help identify pain issues. Here are two suggestions:
    • Q: How often do you experience pain or discomfort? A: Every day; 4-5 days per week; 2-3 days per week; One day per week; Less than one day per week
    • Q: What type of remedy do you use for pain/discomfort? A: Over-the counter products (e.g. ibuprofen or acetaminophen); Prescription strength pain relievers; Prescribed opioid medication