News & Events

Your Plan & Drug Testing During the Opioid Epidemic

Chronic pain is a medical condition that often requires opioid prescriptions for symptom relief. However, the addictive nature of opioid medications have led to a nationwide Opioid Epidemic. Nearly 2.1 million Americans reported an opioid disorder in 2016 and 64,000 deaths from overdose were recorded the same year.1

Aberrant behaviors associated with opioid usage — and determining what is a sign of addiction versus part of stabilizing the patient’s pain condition — has played a significant role in the current epidemic. When behavioral side effects are hard to judge, monitoring patients’ compliance with opioid prescriptions through urine drug testing is a necessary modality. And yet, the cost of this testing ranges from a few hundred dollars to over $1,500.

Knowing opioid addiction is a growing concern and there are significant swings in costs to monitor and mitigate addiction, SISCO takes a two-pronged approach to opioid claims management.

First, when it comes to urine drug testing, we apply a cost-conscious strategy to understand the reasoning and frequency of the testing. In the two examples below, we investigated the nature of the claims and found significant savings for the health plans.

Case Study 1: A SISCO member was billed $47,984.00 for drug testing services used to monitor opioid therapy ($5,998.00 per DOS – 8 dates of services). Through collaboration with Medical Review Institute of America, SISCO found that only $4,789.85 per DOS were eligible.

Savings: $43,194.15

Case Study 2: A SISCO member was billed $101,850.92 for drug testing to monitor opioid use. Due to the treatment and the necessity for testing, no charges were eligible for payment.

Savings: $101,850.92

Secondly, we encourage drug screening for chronic opioid therapy. Through the screening process, we are able to collaborate with medical management and refer members into case or condition management if they appear to be at a higher risk for opioid addiction. Reduced risk of addiction and better managed treatment leads to healthier members and cost savings for the health plan.


1 Another Cost of the Opioid Epidemic: Billions of Dollars in Lost Taxes, U.S. News, April 16, 2019