Featured Research: More Than Just A Headache
Survey finds some employers deficient in handling of migraine disease
Posted on 01-22-2021, Read Time: Min
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According to a new survey from Aimed Alliance in partnership with the the HR Research Institute, there is much confusion among employers about whether migraine disease is considered a disability and a wide variety in the extent to which employers offer both accommodations and appropriate benefits for employees with migraine disease. The survey, “State of Migraine Disease in the Workplace 2020,” polled 309 HR professionals nationwide in virtually every industry to determine how employers perceive migraine disease, provide accommodations, and incorporate practices to help improve the chances of success.
A. What Is Migraine Diseases and Why Should Employers Care?
Migraine disease is a collection of neurological symptoms, usually including severe, throbbing head pain, often accompanied by other symptoms including nausea, sensitivity to light and sound, and visual disturbances. Migraine headaches are typically called episodes or attacks, and these attacks may last between 4 and 72 hours.
Chronic migraine disease, which is characterized by an average of at least 15 migraine attacks per month, is highly disabling, with the World Health Organization deeming it the sixth highest cause worldwide of years lost due to disability. The condition is most common in working-aged adults (i.e., those between 25 and 55) and can substantially impact absenteeism and productivity.
During an attack, 90% of individuals with migraine disease report being unable to work or function normally, while 51% of those who are able to work report their productivity levels are cut in half. Many workers with migraine disease are likely protected under the Americans with Disabilities Act (ADA) because migraine episodes substantially limit one or more major life activities (e.g., ability to think, communicate, see, speak, and work) in many instances.
More than 38 million Americans have migraine disease. Untreated or undertreated migraine disease results in losses of over $13 billion due to reduced productivity per year, as well as 113 million lost workdays due to migraine. Given the disease’s prevalence, it is vital that employers have a clear understanding of the disease, create a welcoming environment free of stigma and discrimination, and offer appropriate benefits and accommodations to both improve workers’ quality of life and limit employers’ risk of liability. Yet, the new survey found serious deficiencies in the workplace regarding migraine diseases.
Chronic migraine disease, which is characterized by an average of at least 15 migraine attacks per month, is highly disabling, with the World Health Organization deeming it the sixth highest cause worldwide of years lost due to disability. The condition is most common in working-aged adults (i.e., those between 25 and 55) and can substantially impact absenteeism and productivity.
During an attack, 90% of individuals with migraine disease report being unable to work or function normally, while 51% of those who are able to work report their productivity levels are cut in half. Many workers with migraine disease are likely protected under the Americans with Disabilities Act (ADA) because migraine episodes substantially limit one or more major life activities (e.g., ability to think, communicate, see, speak, and work) in many instances.
More than 38 million Americans have migraine disease. Untreated or undertreated migraine disease results in losses of over $13 billion due to reduced productivity per year, as well as 113 million lost workdays due to migraine. Given the disease’s prevalence, it is vital that employers have a clear understanding of the disease, create a welcoming environment free of stigma and discrimination, and offer appropriate benefits and accommodations to both improve workers’ quality of life and limit employers’ risk of liability. Yet, the new survey found serious deficiencies in the workplace regarding migraine diseases.
B. Key Findings
Despite caselaw establishing that migraine disease is often a protected disability under the ADA, employers are confused about whether migraine disease is a disability, thereby opening them up for risk of liability.
- Only about half (48%) of HR professionals agreed or strongly agreed that migraine disease can be considered a disability; most others either do not know or say they “neither agree nor disagree.”
- HR participants said 71% of direct supervisors lacked knowledge about migraine disease, and 21% say they themselves lack knowledge.
Employers must educate themselves on migraine disease to reduce stigmatizing their employees and create a more welcoming workplace.
- 40% of participants said direct supervisors think that employees who report migraine attacks are “faking it” or “exaggerating.”
- 39% also said supervisors do not think migraine attacks are a valid reason for missing work, and 36% say direct supervisors do not view the disease as debilitating.
- Only about 61% of HR professionals said employees are comfortable asking their direct supervisors for accommodations related to migraine disease.
Migraine disease takes a toll on employees’ well-being and company productivity, thereby creating an opportunity for employers to offer accommodations and benefits to improve employees’ quality of life.
- 64% of HR professionals reported that employees who have migraine disease have worked even while suffering attacks sometimes, very often, or always.
- Only 1% of participants said migraine attacks do not impair employees’ ability to work.
- Three-quarters of participants said employees with migraine disease use paid or unpaid sick days “sometimes” or more often, and 27% said employees use leave under the Family and Medical Leave Act (FMLA).
Despite acknowledging the toll that migraine takes on employees, employers varied widely regarding how they accommodate employees with this disease.
- Only 56% of HR professionals agree or strongly agree that their organization does a good job of helping and accommodating employees with migraine disease.
- Approximately 36% of HR professionals said their organizations are unlikely to make changes to the workplace to reduce the risk that an employee will experience a migraine episode.
- The most commonly reported accommodations offered to employees with migraine disease were:
- Flexibility in schedules/breaks (56%)
- Telecommute options (51%)
- Alternative lighting (50%)
- When asked what types of support their organizations offer to employees with migraine disease, HR professionals most commonly cite these three types:
- Employee Assistance Programs (EAPs) (72%)
- Health insurance that covers migraine disease (59%)
- Wellness and/or health promotion programs (58%)
Employers may not be offering sufficient health coverage for employees with migraine. Half or more responding HR professionals are not sure about whether their organizations’ health coverage imposes restrictions on medications used to treat migraine disease; among those that do know, however, a considerable proportion imposes such restrictions.
- Excluding those that do not know:
- 49% impose quantity limit restrictions
- 43% impose prior authorization requirements
- 34% impose step therapy requirements
- 18% allow mid-year formulary changes
- 17% implement copay accumulator programs
- If they were convinced the following tactics could reduce costs and help employees with migraine disease:
- 49% would assist those seeking to appeal an adverse benefit determination
- 45% would assist those seeking an exception from a benefit utilization management requirement
- 12% would remove quantity limits
HR professionals are open to offering programs to change the workplace culture around migraine disease and offer their employees support. They indicated they were willing to offer the following programs:
- Migraine training and education for employers and employees (44%)
- Migraine management program (30%)
- Patient navigation service helping employees understand health benefits (24%)
C.Recommendations
Overall, employers should make an effort to include migraine disease treatment and mitigation within their business plans. Employers that perform better in migraine disease management are more likely than others to understand that this disease can be considered a disability, be more aware of the stigma impacting their workforces and take control over them, and have supervisors that are less likely to think employees are “exaggerating” or “faking” migraine disease.
Furthermore, employers who have a culture that supports open lines of communication about accommodations and potential cultural changes, provide more accommodations and deliver greater medical benefits with fewer restrictions, and provide broader wellness programs and support initiatives, are more likely to report positive management of migraine disease within their workforce.
Employers can benefit from reviewing and altering their culture to be more supportive of employees with migraine disease, including creating training programs to educate managers and emphasizing openness and empathy in the workplace. Furthermore, employers should review benefit plans, wellness programs, and policies, procedures, and technologies that may be stigmatizing or fail to provide the necessary support system.
Employers who take action to minimize stress in the workplace while increasing available and personalized benefits and accommodations will help ensure workers with migraine disease are able to manage their symptoms and continue to be productive members of the workplace.
Furthermore, employers who have a culture that supports open lines of communication about accommodations and potential cultural changes, provide more accommodations and deliver greater medical benefits with fewer restrictions, and provide broader wellness programs and support initiatives, are more likely to report positive management of migraine disease within their workforce.
Employers can benefit from reviewing and altering their culture to be more supportive of employees with migraine disease, including creating training programs to educate managers and emphasizing openness and empathy in the workplace. Furthermore, employers should review benefit plans, wellness programs, and policies, procedures, and technologies that may be stigmatizing or fail to provide the necessary support system.
Employers who take action to minimize stress in the workplace while increasing available and personalized benefits and accommodations will help ensure workers with migraine disease are able to manage their symptoms and continue to be productive members of the workplace.
Author Bio
| Stacey Worthy is a Counsel to Aimed Alliance. With over a decade of experience, she provides counsel to nonprofit organizations; health care programs and providers specializing in pain and addiction medicine; clinical laboratories; and pharmaceutical, biotechnology, and medical device companies in various aspects of their legal, regulatory, and business affairs. Visit https://aimedalliance.org/ Connect Stacey Worthy Follow @aimedalliance |
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