To create an effective strategy for dealing with the opioid crisis, you have to first get to the root of the problem: Poor pain control for the millions of people in chronic pain.²⁶ Despite the high prevalence of pain in America today, access to ideal treatment is often difficult due to the many barriers and social stigmas in the way. Pain is a complex, unique, subjective experience that often produces psychological and emotional effects such as depression, anxiety and anger. For this reason, an interdisciplinary approach to treatment is recommended.²⁷ Options include medications, surgery, physical and psychosocial therapies, as well as complementary and alternative medicine.

Benefit Design Strategies

Work with vendor partners to evaluate your current strategies and review your benefit design approach for any necessary changes to better support employee health and safety and ensure care coordination related to pain management. Click here for top benefit design questions for employers to explore for medical, pharmacy, dental and wellness plans.

Essential recommendations for PBMs include:¹

• Review when opioids can be prescribed for chronic pain. Consider prescription only after failure of, or in conjunction with, first line non-opioid and non-pharmacologic therapies for painful conditions
• Consider quantity limits per opioid fill for acute pain (3-7 days)
• Require immediate release formulations be prescribed before long-acting opioids

Click here for a comprehensive checklist of Benefit Design Considerations for PBMs

Essential recommendations for health plans include:¹

• Evaluate coverage options to ensure treatment approaches are affordable, convenient and easily accessible
• Allow for referral to comprehensive pain centers when appropriate; ensure access to pain specialists, often better suited than a PCP to prescribe pain medications such as opioids
• Design a pathway for employees with chronic pain to achieve appropriate care and encourage collaboration between the primary care physician and any pain specialists the patient is referred to see

Click here for a comprehensive checklist of Benefit Design Considerations for Health Plans

The focus of your benefit design strategy should be on the appropriateness of treatment, based on a patient’s conditions and quality metrics for the top priority conditions, and should include non-drug treatment options.¹ A balanced approach will ensure that people who legitimately need prescription pain medications have access and misuse/abuse can be kept to a minimum.

Overall, consider these three key steps for mitigating pain in the workplace:²⁶

1. Launch a campaign to educate your employees about self-care options; use posters, flyers, newsletter articles, meeting, e.g. staff, shift and safety meetings
2. Allow employees access to complementary therapies such as physical therapy, massage and acupuncture
3. Don’t forget about the psychological factors around pain. Fear can be a big barrier to healing. Cognitive Behavioral Therapy (CBT) can teach those in chronic pain new strategies and skills for coping.²⁸