Based on Ohio's opioid prescribing guidelines, we developed an opioid prescribing rule that applies to all BWC-certified prescribers. It's designed to help prevent opioid dependence
for Ohio's injured workers through its three primary goals.
- Encourage prescribers to incorporate best clinical practices when prescribing opioids for treating Ohio's injured workers.
- Establish provisions and criteria for treating opioid dependence that arises secondary to treatment with opioid medications covered by BWC.
- Provide and strengthen BWC's peer review processes for opioid prescribing that address noncompliance with opioid prescribing and other quality of care issues in our system.
Best clinical practices
We will not reimburse for opioid prescriptions written by prescribers who fail to comply with Ohio's best prescribing practices as outlined by the Ohio State Medical Board and reinforced by the Ohio Administrative Code (OAC).
The rule reinforces important foundational elements of appropriate opioid utilization and customizes it for our population. Because injured workers have a vulnerability that differs from the general population, an additional level of opioid prescribing
oversight is required by prescribers. The rule outlines the details needed for this necessary oversight.
Checkpoints: Tighter controls on duration and daily dose of opioid prescribing, as measured by milligrams of Morphine Equivalent Dose (MED)
Pay attention to the duration of time an injured worker may be on opiates. For example, prescriber dose/duration checkpoints to review pain treatment plans are:
- 50 mg MED/Day for more than six weeks after injury or during the subacute injury phase;
- 80 mg MED/Day or for more than 42 to 84 days;
- 80 to 120 mg MED/Day or for more than 12 weeks for the chronic pain phase.
Opioid treatment programs reimbursed
Be aware of red flags that may arise when treating the injured worker. Fortunately, BWC ensured the rule includes policies for supporting an injured worker and his or her physician if the injured worker receiving opioids covered by BWC wants to stop using them.
BWC will reimburse for opioid treatment programs that include medication assisted treatment, behavioral and psychological counseling and inpatient detoxification. If necessary, BWC will reimburse for up to 18 months as long as the injured worker follows the plan
developed collaboratively with his or her physician. For added safeguards, this rule allows the injured worker to relapse twice during the 18-month period. In addition, the injured worker may complete these programs without adding drug dependency as an allowed
claim condition as long as the injured worker has a treatment plan.
Peer review will now be included as a new component of utilization review for BWC prescribers as outlined in the rule. Although this process falls outside our progressive disciplinary process, it similarly could result in BWC decertifying a physician.
For more information about this rule, email BWC pharmacy benefits.
* (OAC 4123-6-21.7)