By Phil Walls, RPh, Chief Clinical Officer, myMatrixx
As of this writing, more than 116,576,359 people in the United States have been fully vaccinated for COVID-19, or 35.1 percent of the population, according to data from the Centers for Disease Control (CDC). The CDC is also currently reporting a decrease of 81% in the rolling seven-day average of reported new cases of COVID since peaking on January 8, 2021. These and other indicators point to us truly starting to come out of the pandemic that has gripped the country and world for more than a year.
This is certainly great news, but even as the economy begins to restart and people return to jobs and job sites, there are a range of COVID-related issues that those of us in workers’ compensation and general healthcare are just beginning to understand. In preparing our 2020 Drug Trend Report, the myMatrixx clinical pharmacy and business intelligence teams spent a lot of time reviewing the previous year’s data, including data illustrating how COVID-19 may have affected workers’ compensation pharmacy. We believe these findings will be an important foundation as we continue to explore the long-term effects of the pandemic.
As we move forward, managing emerging issues will require careful comparison to existing clinical data and a proactive approach to claims management to help ensure proper utilization and patient safety. In particular, opioid use, behavioral care and the long-term consequences of COVID-19 presumption in workers’ compensation are three areas that will be receiving close attention.
1. How the Pandemic Affected Opioid Use
It’s becoming increasingly clear that COVID-19 affected opioid use among injured workers and the general population in several ways. Multiple sources, including data from the CDC, pointed to a significant uptick in overdose deaths during the pandemic. While the majority of these overdoses were related to synthetic opioids on the illegal market such as fentanyl, the uptick likely reflects the increased disruption of daily activities and reduced access to care so many faced in 2020.
For example, a large number of opioid users requiring addiction recovery were not able to receive the care they needed due to the pandemic. Not having access to important counseling and highly regulated medication-assisted treatment may be contributing to the increased overdoses we’re seeing.
Additionally, some injured workers who saw delays in treatments such as surgery turned to opioids to manage pain in the interim. A significant number of patients who seek elective surgery for orthopedic conditions such as hip or knee pain use opioids to manage their symptoms. According to a recent study, 20% of patients undergoing knee replacement surgeries delayed by the pandemic were using opioids and are potentially at an elevated risk for opioid use disorder.
Yet another concern to monitor is a growing trend of opioid prescriptions for patients dealing post-COVID-19 syndrome, or “long COVID.” Research published in Nature demonstrated that doctors are prescribing opioids for long-term post-COVID patients at a higher rate compared to average prescription rates.
Looking at data from our Drug Trend Report, although workers’ comp prescription drug programs managed by myMatrixx saw a 1.2% decline in opioid spending in 2020, it was a lower rate of decline compared to previous years. With the prevalence of indicators pointing to this trend connected to COVID-related factors, clinical pharmacists need to continue close monitoring of opioid use in 2021.
2. Increased COVID-related Behavioral Health Needs
It’s been widely discussed that social distancing, quarantining and overall uncertainty resulting from the pandemic caused an increase in mental health concerns. We have every reason to believe that injured workers, who already undergo a quarantine-like experience at the individual level, were particularly affected by this. According to the myMatrixx Drug Trend Report, use of medications for the treatment of mental health conditions increased between 2019 and 2020, with antidepressant use rising by 16% as just one example.
Behavioral care, including medication, has been a growing concern for years in workers’ compensation and it will require additional attention in the wake of the pandemic. This is because not addressing the mental health of injured workers can increase the duration of claim, delay return-to-work and increase the risk of opioid addiction, among other negative outcomes. However, behavioral care in workers’ compensation requires careful clinical oversight to ensure drug therapy is utilized safely and effectively.
This is especially true in chronic pain cases, where combinations of opioids and certain psychotropic drugs, such as benzodiazepines, are associated with especially high claim durations and costs. As just one example, data from our 2020 report shows injured patients taking short-acting opioids in combination with prescription benzodiazepines is associated with nearly tripled claim costs. Through interventions such as weaning programs and non-pharmacological treatment such as cognitive behavioral therapy, injured workers can reduce dependency and work toward better outcomes.
3. The Long-term Effects of COVID-19 Presumption
In terms of treating COVID-19 itself, the effect on workers’ compensation retail pharmacy has been relatively limited so far. For 2020, we reported that COVID-19 treatment consisted of less than a percent, or 0.025%, of total retail pharmacy spending for our clients. Some employers saw no exposure, with many compensable workers’ compensation cases being limited to first responders and frontline healthcare workers. In these cases, the majority of drug therapy was administered in the hospital, while retail prescriptions were only needed for treatments such as inhalers and cough suppressants.
However, as mentioned in the opioid discussion above, post-COVID-19 syndrome is proving to be a long-term issue that will undoubtedly affect workers’ compensation cases moving forward. Like other aspects of workers’ compensation law, presumption for COVID-19 cases is being handled on a state-by-state basis. In states with presumption for COVID-19, work-related post-COVID-19 syndrome cases will likely be compensable.
As physicians and medical researchers continue to understand how COVID-19 affects people on a long-term basis, the list of related conditions keeps growing. From fatigue and brain fog to serious cardiac and pulmonary complications, there is a high likelihood of these emerging issues requiring new and potentially expensive drug therapies prescribed for at-home use. As just one example, I recently wrote an update on the clinical trial for Ofev, an oral medication for pulmonary fibrosis that is being tested for post-COVID-19 lung fibrosis. Currently, this drug is being prescribed off-label for COVID-related cases and FDA approval or a therapeutic use authorization would be an important step in removing price barriers for utilization.
It’s clear that even as it looks like the United States and much of the world is turning the corner on this health crisis, it will continue to be a part of our lives. In workers’ compensation pharmacy, ensuring positive outcomes for injured workers and responsible drug therapy will require careful clinical oversight and an evidence-based approach. Whether it’s ongoing monitoring of opioid utilization, developing new approaches to behavioral care or identifying potential long-term COVID patients and developing appropriate formularies, the myMatrixx clinical pharmacy team will keep a forward-looking view on the pandemic.
If you’re interested in learning more about these and other major drivers in the industry, myMatrixx invites you to explore their 2020 Drug Trend Report.
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This is a sponsored post from WorkCompWire marketing partner myMatrixx.