Opioids are costing your health plan more than you think…
Find out how much with an Opioid Impact Estimate
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This Florida school district realized $1.45 million in first-year savings. Imagine what that could mean for your health plan.
Please note this report reflects direct costs only and does not include indirect impacts such as absenteeism, presenteeism, workplace injury avoidance, or lives saved.
Unseen Risk Is Your Most Expensive Line Item
By identifying prescribing patterns and their downstream impact, employers gain a clear view of where risk – and unnecessary cost – exists.
Carving out opioids from the plan reveals one of the most consistently overlooked cost drivers, with the opportunity to reduce total health plan spend by 6–8%.
School District
Identified hidden opioid-related cost drivers within a large employee population and aligned providers to best practices through targeted intervention.
Health Plan SAVINGS: $1.45 Million
TPA
Equipped a TPA with actionable prescribing insights to uncover avoidable costs across client plans and drive provider behavior change.
Health Plan SAVINGS: $2.28 Million
Association Plan
Analyzed prescribing variation across a diverse membership to identify risk and standardize care through provider education.
Health Plan SAVINGS: $2.14 Million
Why this matters to your health plan
Nearly 1 in 3 members will be prescribed an opioid – introducing risk that directly impacts cost, safety, and workforce performance. By addressing prescribing early and carving out opioids, employers can reduce total health plan spend while improving outcomes across the plan.
Protecting Members at the Point of Injury
Workplace injuries are one of the most common entry points into opioid use. Intervening early ensures members recover safely, avoid unnecessary exposure, and return to work without added risk.
Reducing Total Plan Spend
Opioid-related prescribing drives higher medical costs, extended disability, and lost productivity. Identifying and addressing risk early can reduce total health plan spend by 6–8%, while avoiding thousands in downstream costs per member.
Protecting What Matters Beyond the Workplace
When dependency develops, the impact extends far beyond the individual—affecting families, stability, and communities. Prevention safeguards not just employees, but the people who rely on them.
Enabling Better Care Decisions
When members are connected to opioid-free options and informed choices, outcomes improve. Safer pathways lead to faster recovery, fewer complications, and more confident decision-making.
From Awareness to Early Intervention & Education
There’s More at Risk Than Patients Know
Research shows that 10% of individuals undergoing elective surgery will develop opioid dependence – just because they were exposed during routine medical care. And on average, one in three health plan members who receive an opioid prescription for pain are at measurable risk for developing dependency.
This isn’t an issue of personal choice – it’s a predictable, preventable exposure pathway embedded in standard care today.
How Addiction Impacts Your Spend
A University of Michigan / IBM Watson study found that one opioid prescription after elective surgery = +$7,700 in total spending within 12 months.
Research further shows that plan members dependent on painkillers have three times more healthcare encounters and can cost a health plan up to eight times more.
Are Providers Truly Informed?
Unfortunately, no. Most opioid prescribers lack formal training in pain management and do not fully understand the risks associated with opioid use. This gap in education contributes to prescribing practices that may inadvertently increase the likelihood of dependency and adverse outcomes for patients.
That’s why we are focused on changing this upstream – through provider education, certification, and accountability – so safer, opioid-avoidant care becomes the standard, not the exception.
Offering Results That Matter
Opioid Free America is partnered with an AI solution built on years of data from one of the nation’s most successful addiction treatment centers – real-world patient insights turned into prevention logic. Now active in 1,700 plans across 40 states – we turn claims data into targeted action. Results include:
- 60-75% reduction in high-risk prescribing
- 3-5% total plan savings
- fewer disability claims, fewer tragedies, and stronger communities