Mike Sullivan, President of Cubic Health Inc., says that most plan sponsors would be surprised at the extent to which the abuse of narcotics and controlled drugs can affect their plans. “Some plan sponsors assume that there is a method for pharmacies, insurance carriers and/or claims processors to deal with this issue at the point of sale, but that is not always the case,” he says.

This is a sensitive issue for plan sponsors because there is no upper limit for narcotic dosing. Sullivan says the current system needs better controls in place to address the problem of people seeking multiple narcotic prescriptions from one or more physicians that lead to extremely high or dangerous usage patterns.

Sullivan says the private plan sponsor who has the individual enrolled as an employee or spouse within the plan typically pays the bill in the majority of cases. Given the major side effects of narcotic abuse in the workplace, and potential legal liability issues if a plan allows members to claim and receive as many narcotics as they choose, the need for even a basic drug plan performance review is critical.