Opioids and Vendors Rhode Island Business Group on Health: Opioid Summit June 8, 2018

Agenda Overview Solutions Building Partnerships Triple AIM Best Practices in the Marketplace Building Partnerships What does success look like? Cross-functional Solutions Welcome everyone. In today’s webinar we will be discussing the world of genomics. Our purpose is to educate and prepare consultants to have conversations with clients. Therefore, our presentation today seeks to: Cover the broad categories in genomics. Discuss key terms, look at the continuum of life and where various genetic interventions may occur. Look at what insurers may cover and how much they may cover. Articulate Aon’s POV and highlight pitfalls to avoid when discussing with your clients.

Defining the Opportunity Member experience is improved. Population health improves during cultural transformation. Employees receive evidence-based treatment for conditions for pain or opioid use disorder and addiction. Quality should improve while costs abate. Member Experience Population Health Value

Opioid’s Impact at the Workplace Long Term Disability Opioids are a treatment modality used for chronic pain management Social Security Disability Insurance SSA does not allow disability benefits for addiction Stay at Work Undisclosed opioid use may not be recognizable Potential to cause impairment Incidents, errors and injury even when taken as prescribed Opioid use may not be readily apparent or considered Short Term Disability Opioids are often prescribed after surgery to manage pain An employee recovered from a primary disabling condition can have an absence extended if the employee becomes dependent on prescribed opioids A history of depression is a risk factor for dependence Workplace Absenteeism Workers with pain medication use disorder miss 3 times more work – 29 days/ year1 Individual and Organization Wellbeing Return to Work (RTW) An employee recovering from an illness, injury or surgery may still be taking opioids upon RTW 1 www.safenebraska.org/index.php/download_file/view/2800/1763

What Is Happening in the Workplace? Opioid Policies In the Workplace Are Inadequate 81% lack a comprehensive drug-free workplace policy 70% would like to help employees return to work following appropriate treatment 76% are not offering training on how to identify signs of misuse Which Industries Have Highest Opioid Use Disorder Prevalence? Average/Below (6-9.4% prevalence) Moderate (9.5-10.6% prevalence Highest (15% prevalence) Education, health, social services Public administration Finance, insurance real estate Wholesale, durable Other services except public administration Agriculture Manufacturing durable Manufacturing nondurable Transportation, utilities Information, communications Professional, management, administration Wholesale, nondurable Mining Retail Entertainment, recreation, food Construction 41% of those who drug test all employees are not testing for synthetic opioids. More than 70% of U.S. employers are feeling the direct impact of prescription drug misuse in their workplaces Source: http://www.nsc.org/NewsDocuments/2017/Media-Briefing-National-Employer-Drug-Survey-Results.pdf

State Activity – Opioid Crisis 5

Location of Treatment Location of Treatment Condition Treated Description Hospital Acute Intoxication Overdose: requires life support Residential Significant Withdrawal Symptoms Controlled/supportive environment Outpatient Impaired Functioning Ongoing follow up, social support, mental health

Medication-Assisted Treatment (MAT) Definition A comprehensive approach to opioid use disorder that includes: Medications: Physiological support (cravings, withdrawal) Psychological support Social resources Testing/follow up Maintenance Therapy: can last years Is MAT Therapy Effective? More likely to stay in treatment Less likely to use heroin Decreases overdose deaths Reduces transmission of HIV Reduces transmission of Hepatitis C Reduces other infectious diseases No MAT Therapy + MAT Therapy >90% of heroin users relapse1 50% reduction in relapse2 1https://drugabuse.com/library/heroin-relapse/ 2http://www.nsc.org/NewsDocuments/2017/Media-Briefing-National-Employer-Drug-Survey-Results.pdf

Challenges to Overcome “Less than 1/2 of privately-funded substance use disorder treatment programs offer MAT and only 1/3 of patients with opioid dependence at these programs actually receive it.” Employers can impact opiate use through: Prevention Treatment Support “Stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help.”1 1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045214/?report=reader

Changing Opioids Through Population Health Initiatives Which Vendors Have the Highest Impact on Reducing Opioids? Aspirational Moderate Highest Educational programs for opioid safety Destigmatize treatment Integrate PBM, EAP, Carrier, Dental, ACO Legislative agenda Ensure only evidence-based treatments though benefit design: medical and pharmacy Ensure polypharmacy controlled substances are reduced. Ensure out of network residential treatment programs not incentivized Ensure absence and disability programs address unique aspects of opioids Training program for supervisors for recognizing opioid abuse Update workplace policies for prescription drug use PBM Geo-based urine drug screens Provider removal from network Analytics for quarterly monitoring 41% of those who drug test all employees are not testing for synthetic opioids. More than 70% of U.S. employers are feeling the direct impact of prescription drug misuse in their workplaces

Goal: 95% compliance with CDC guidelines by July 1, 2020 The Metric of Success Goal: 95% compliance with CDC guidelines by July 1, 2020 Many states have embraced prescription controlled drug monitoring programs, which allows clinicians to instantly determine if others are prescribing opiates to the same patient. There are bottlenecks in creating an adequate supply of clinicians willing and able to prescribe buprenorphine As a result of today’s limited access, buprenorphine’s street value (not prescribed through legal means) has surged to $25.00 per pill. SAMSHA recently granted nurse practitioners and physician assistants authority to prescribe buprenorphine. This could increase access by another 10%. Physicians have been granted expansion of the number of patients that can be treated to 275 per month, up from 30 patients. This will have a dramatic impact on access nationwide. All clinicians are required to complete specialized training before prescribing buprenorphine Temporarily increase and quickly hire specialty personnel needed to offer treatment (pending funding) to provide support Telemedicine Services – to increased access of services to certain groups of patients struggling with opiate addiction Flexibility with grant money A new policy from the Trump Administration is pending that will announce more facilities ability to offer services The action allows for shifting of resources within HIV/AIDS programs to help people eligible for those programs receive substance abuse treatment, which is important given the connection between HIV transmission and substance abuse Drug Monitoring Programs have produce sustained reductions in opiate prescribing Some Pharmacy Benefit Managers, Carriers, and Pharmacies, and medical schools have publically committed to new educational efforts and policies which will incrementally reduce opiate prescriptions.