Education is Key to Prevent Dangerous Opioid Drug Combinations

There is good news on the opioid front in the workers’ compensation system. According to the latest Workers’ Compensation Drug Trend Report from myMatrixx, an Express Scripts company,

 

  • Average spending on the drugs declined 11.9 percent
  • The percentage of injured workers using opioids for at least 30 days decreased by a couple of percentage points
  • The morphine-equivalent dose (MED) declined — with a 33.7 percent reduction in cumulative MED greater-than 100 and a 26.9 percent decrease in cumulative MED overall.

 

But the good news is tempered by the persistent problem of opioids prescribed in conjunction with other medications that together form a dangerous interaction. While the numbers were somewhat better in 2017 than the previous year, there are still too many injured workers being put at risk for overdoses and death. Education and outreach are needed to address the problem.

 

 

The Facts

 

According to the Drug Trend report, 74.2 percent of payers spent less on opioids in 2017 than in 2016. The average amount per claim declined to $342.57, compared to $388.80 in 2016. Opioids continued to be the most expensive and highly used class of drugs among injured workers and accounted for 24.1 percent of total pharmacy spend in 2017.

 

“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” according to the report. “Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while 9 percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.”

 

The report showed that in 2017

 

  • 7 percent of injured workers took an opioid and a muscle relaxant, compared to 31.1 percent in 2016.
  • 3 percent took an opioid and a benzodiazepine last year, compared to 7.3 percent the previous year.
  • 5 percent took an opioid, a muscle relaxant and a benzodiazepine in 2016, compared to 3.1 percent in 2016.
  • Among injured workers using opioids for a short-term (less than a 30 days’ supply), 79.6 percent used opioids only, and4 percent used an opioid and a muscle relaxant.
  • For injured workers using opioids for more than 30 days, 36.1 percent filled both an opioid and a muscle relaxant.

 

Despite the slightly better news, there is still much to be done to curb the problem of combining opioids with certain other drugs. The federal government reports more than 30 percent of overdoses involving opioids also involve benzodiazepines or ‘benzos.’ These drugs are used to help anxiety, insomnia, muscle tension, seizures, and alcohol withdrawal. Both benzos and opioids suppress breathing, sedate users and impair cognitive functions.

 

Benzos are commonly sold under the names Valium, Xanax, and Klonopin. Additionally, some benzos, have muscle relaxant properties and are often prescribed for injured workers with muscle spasms.

 

The Centers for Disease Control and Prevention issued new guidelines in 2016 that recommend clinicians avoid prescribing benzos concurrently with opioids whenever possible. Both opioids and benzo medications now carry warnings from the Food and Drug Administration (FDA) highlighting the dangers of using the drugs together.

 

Research clearly shows the dangers of combining opioids with benzos. In a North Carolina study, for example, researchers found the overdose death rate among patients receiving both types of medications was 10 times higher than among those who only received opioids.

 

Part of the problem is that physicians may prescribe opioids on a long-term basis to treat acute or chronic pain, along with Valium to treat muscle spasms. Injured workers may also receive a Xanax prescription from a therapist if they suffer from anxiety.

 

 

Additional Medication Dangers

 

In addition to muscle relaxants and benzos, many other medications can be harmful when taken in combination with opioids. The FDA has issued warnings for physicians to limit their prescribing of the following for patients on opioids:

 

  • Antidepressants
  • Migraine medications
  • Antipsychotic drugs
  • Sleep medications
  • Serotonergic drugs, such as St. John’s wort.

 

There’s also evidence that antihistamines, which can cause drowsiness and sedation, may be problematic when combined with opioids. Finally, mixing alcohol with opioids can be deadly.

 

 

Risks

 

Over sedation and depressed breathing are two of the biggest problems resulting from a mix of opioids with other medications. Over sedation renders the person unable to wake up or respond to stimuli, creating risks for falling or slipping into a coma. Depressed breathing leads to a lack of oxygen to the brain and eventually shuts down vital organ systems, causing brain damage or death.

 

There are additional risks as well.

 

  • Serotonin Syndrome, a serious central nervous system reaction occurs when high levels of the chemical serotonin build up in the brain and cause toxicity. Symptoms may include agitation, hallucinations, rapid heart rate, excessive sweating, shivering, muscle twitching and trouble with coordination.

 

  • Adrenal insufficiency is a rare but serious condition in which adequate amounts of the hormone cortisol cannot be produced. Cortisol helps the body respond to stress. Symptoms of adrenal insufficiency include nausea, vomiting, loss of appetite, fatigue, weakness, dizziness or low blood pressure.

 

  • Decreased sex hormone levels are associated with long-term use of opioids and can reduce the person’s interest in sex, or lead to impotence or infertility.

 

Knowing the symptoms of an overdose is important, and may include

 

  • Pinpoint pupils
  • Unconsciousness
  • Dizziness or lightheadedness
  • Extreme sleepiness
  • Slowed, irregular breathing
  • Confusion
  • Unresponsiveness
  • Blue lips
  • Snoring or gurgling sound in the throat

 

Educating patients and physicians about the dangers of combining opioids with many other medications is the first step to reduce the problem. Those managing claims should reach out to prescribers to ensure they understand the risks of interaction.

 

Conclusion

 

The combination of opioids with other medications should only be prescribed to patients who do not respond adequately to other treatments. If they do, the dosages and duration of each medication should be the lowest amount possible.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Practical Tips for Implementing Urine Drug Testing

Identifying and intervening with at-risk injured workers can save payers a bundle. These are the so-called “creeping catastrophic’ claims; the seemingly minor injuries expected to resolve within weeks that go south and before you know it, have been on the books for months or longer. They typically involve a variety of expensive medical procedures and medications, all of which are unsuccessful in alleviating the person’s pain.

 

This small fraction of workers’ compensation claims encompasses a majority of costs for payers. In recent years, the industry has done a better job of red-flagging these claimants earlier in the process. But an oft-overlooked tool to help is urine drug testing.

 

Urine Drug Testing helps physicians whether the patient is compliant with prescribed medications and/or using non-prescriber or illicit drugs.

 

But UDT has been ignored in many cases or overused in others. Using UDT judiciously can be a tremendous help.

 

 

The Stats

 

Recent research shows fewer than half the injured workers prescribed opioids received UDT – 17 percent to 50 percent. However, it also showed that of the top 5 percent of claims, UDT was conducted in 7 out of 10 physician visits.

 

Guidelines from the American College of Occupational and Environmental Medicine, the Official Disability Guidelines and the Washington State Interagency vary regarding UDT frequency recommendation. But they all call for UDT at baseline when opioids are initially prescribed, then at various times throughout the year based on the injured worker’s risk stratification. Those at low risk may only need UDT every six months to annually; while high-risk claimants might need to be tested monthly.

 

The testing provides objective information to support improved clinical decision making, and helps medical providers:

 

  • Monitor and support their decisions about medications.
  • Identify recent use of prescription and illicit substances.
  • Detect medications that may negatively interact with other drugs.
  • Better communicate with their patients about their treatment plan.
  • Identify possible medication abuse and misuse.

 

A recent national sampling of more than 11,000 testing specimens revealed that fewer than half – 47 percent – adhered to their treatment regimens. That means more than half were not taking their medications as prescribed, taking other medications that were not prescribed, or used illicit substances. It is, therefore, incumbent on organizations to include UDT as part of their treatment plans for injured workers prescribed opioids – especially those at higher risk.

 

 

Whom to Test

 

Testing all injured workers might not be feasible or practical. However, there are certain injured workers who should undergo UDT. Identifying those at risk for delayed recovery can involve several steps. One is risk factors for substance abuse disorders, such as:

 

  • History of substance abuse disorder.
  • Family history of substance abuse.
  • Major psychiatric disorder.
  • Cigarette smoking.
  • Preadolescent sexual behavior.
  • Poor family support.

 

Injured workers with no history of substance abuse – their own or their families, and no psychiatric history or other risk factors would be considered at low risk for substance abuse disorders. They should undergo UDT when opioids are initially prescribed, then yearly. It should be noted, however, that a person’s risk level can change. Medical providers should be instructed to watch for aberrant behavior or any signs of a problem.

 

Injured workers with substance abuse histories of non-opioids, and/or factors such as family history of substance abuse or psychiatric histories would be considered at moderate to high risk and should be tested two to four times per year, as well as when they initially prescribed opioids.

 

 

Patients Found Abusing

 

Those who are currently abusing or addicted to substances and/or have psychiatric histories or other factors present would be considered high-risk patients. These patients should no longer receive opioids from their primary physician and be referred for addiction therapy.    These injured workers should be tested at least three times a year and possibly as much as monthly, according to the guidelines.

 

Data from pharmacies can also be helpful in identifying injured workers at higher risk. Pharmacy benefit managers can help identify at-risk claimants based on their patterns of medication use, for example.

 

Once an injured worker has undergone testing, it’s important to have an expert interpret the results and help determine whether and what type of intervention may be necessary. Expert interpretation is generally provided by the testing lab. An employer may also consider consulting with a medical advisor.

 

 

Practical Tips for Employers / Payers Implementing UDT

  • Avoid poor quality and abuse by not letting doctors complete their own testing.
  • Contract for a panel of tests with a reputable lab.
  • Direct testing from physicians to the preferred lab.

 

Conclusion

 

There are a variety of tools that can help early identification of injured workers at risk of poor outcomes. UDT can be valuable when it is done with the proper frequency, and when the results are accurately understood and acted upon.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

U.S. Workers’ Compensation Prescription Drug Spending Decreased 3.3 Percent in 2017

ST. LOUIS /PRNewswire/ — Workers’ compensation pharmacy spending decreased 3.3 percent in 2017, according to new data released by myMatrixx, an Express Scripts (NASDAQ: ESRX) company.

“By merging the core capabilities of Express Scripts and myMatrixx to deliver superior clinical expertise, market-leading client experiences and innovative technology-based solutions, myMatrixx is now uniquely positioned to serve workers’ compensation clients and injured workers,” said Phil Walls, RPh, Chief Clinical Officer for myMatrixx. “We’re doing more to help clients balance appropriate care for injured workers while keeping costs down.”

 

More than half of myMatrixx Workers’ Compensation plans reduced drug spending last year.

 

 

Curtailing the Opioid Epidemic

 

Spending on opioids declined 11.9 percent for workers’ compensation payers in 2017.

 

For decades, myMatrixx has championed safe and appropriate use of opioids through solutions that leverage data, educate those at risk for adverse events and ensure connectivity across the care continuum. In addition, many states have taken action to address the opioid crisis through a multifaceted approach involving state-specific formularies, opioid guidelines and limits on initial opioid dispensing days’ supply and/or morphine equivalent dose.

 

These factors resulted in 74.2 percent of workers’ compensation payers spending less on opioids in 2017 than in 2016.

 

“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” said Brigette Nelson, senior vice president of workers’ compensation clinical management at myMatrixx.

 

myMatrixx research found dangerous drug combinations and long-term use of opioids still pose care and cost concerns. Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while nine percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.

 

By deploying a holistic approach to manage opioid use, myMatrixx works with physicians, pharmacists and injured workers to mitigate the concerns of drug interactions or overuse.

 

Additionally, myMatrixx noted by the eleventh year of injury, the cost per injured worker reached $3,402.07, with $1,862.36 spent on opioid medications. Among those with age of injury of 10 years or more, more than half filled an opioid medication in 2017.

 

 

Compounded Medications Decline Further

 

For the third year in a row, spending on compounded medications decreased – a decline of 37.9 percent in 2017, falling out of the top 10 therapy classes.

 

While compounded medications continue to be a focus because of their high cost, it is clear that effective management strategies can reduce unnecessary costs and waste associated with clinically unproven ingredients.

 

 

Specialty Medication Utilization Remains Low, but Growing

 

Spending on specialty medications to treat conditions such as HIV and osteoarthritis increased 3.8 percent in 2017. While these drugs represent less than 1 percent of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.

 

“Payers who have injured workers with occupational exposure to needle-sticks often include HIV medications on their formulary to ensure quick access to work-related HIV prophylaxis therapy,” Nelson said. “This therapy class saw the highest spending among specialty medications.”

 

 

Other Key Findings of the Workers’ Compensation Drug Trend Report include:

 

  • Generic fill rate increased to 85.6 percent across our workers’ compensation payers in 2017. Yet, payers could have saved $80.8 million through an optimal mix of clinically appropriate generic options.

 

  • The average cost of a physician-dispensed medication was $270.70, compared to $108.49 for a pharmacy-dispensed medication. This means plans paid a $162 premium for physician-dispensed medications which bypass pharmacist review at the point of sale. Of the medications dispensed by physicians, nearly half are used to treat pain.

 

  • On average, payers spent $1421.36 per injured worker for prescription medications in 2017.

 

 

About the 2017 myMatrixx Drug Trend Report

 

The 2017 myMatrixx Workers’ Compensation Drug Trend Report is among the industry’s most comprehensive analyses of workers’ compensation drug spending in the U.S. In its 12th edition, the research examines de-identified prescription drug use data of injured workers with a pharmacy benefit plan administered by myMatrixx. The report also includes analysis of state and federal government regulations and their impact on pharmacy-related challenges in workers’ compensation.

 

In calculating trend, prescription drug use was considered for legacy Express Scripts clients with a stable injured-worker base, defined as having a change in user volume of less than 50 percent from 2016 to 2017.

 

The comprehensive review of trends in prescription drug spending for workers’ compensation plans is available at myMatrixx.com

 

 

About myMatrixx, an Express Scripts company

 

myMatrixx® is a full-service workers compensation pharmacy benefit management company focused on patient advocacy. By combining agile technology, clinical expertise and advanced business analytics, myMatrixx simplifies workers’ compensation claims management. Located in Tampa, Florida, myMatrixx has positioned itself as a thought leader in the workers’ compensation industry.

 

For more information, visit myMatrixx.com

 

Media Contacts:
Phil Blando
202-258-4978
PJBlando@express-scripts.com

 

Ellen Drazen
314-684-5355
EVDrazen@express-scripts.com

 

 

SOURCE myMatrixx

Related Links

http://www.mymatrixx.com

Eliminate Physician Dispensing To Reduce Prescription Drug Costs

Eliminate Physician Dispensing To Reduce Prescription Drug Costs

One of the driving factors in workers’ compensation cost containment is pharmaceutical waste.  This waste is having a significant impact on the medical costs associated with claims.  Seeking partners that have solutions to reduce waste can lead to a more effective program and benefit all interested stakeholders.

 

 

Waste in Pharmacy Benefits Defined

 

The concept of “waste” can be defined as the extra amount of money spent with no incremental gain in health outcomes.  In the area of pharmacy benefits, this most often takes place when prescription medications are dispensed through more expensive methods of delivery to the injured worker, for example through the physician’s office directly. It can also be the result of inexperienced healthcare consumers—the injured worker—making misinformed decisions on where to receive their prescription medications.

 

 

Trends in Work Comp Pharmacy Benefits Costs

 

According to Express Script’s Workers’ Compensation Drug Trend Report, payers spend 58% more for physician-dispensed medications than for pharmacy-dispensed medications. Also, medications dispensed via home delivery will often realize a greater discount than pharmacy-dispensed medications.

 

The 2016 NCCI Workers’ Compensation and Prescription Drugs Research Brief states “recent Rx findings include the countrywide 2014 physician‐dispensed share of prescription drug costs was 10%…in highly regulated states the physician‐dispensed share of prescription drug costs was less than 2%…if not highly regulated…costs exceeded 20%.”

 

 

Convenience and Safety

 

The most attractive feature of physician dispensing for the injured worker is convenience.  However, it is important to recognize that medications dispensed from a physician’s office are not subject to the same safety controls and oversight as in retail or home delivery pharmacy.

 

 

Do Not Allow Physician Dispensing

 

If the employee’s medical provider has been dispensing medication to the injured employee from the provider’s office, send a letter to the employee, employee’s attorney, and the doctor advising that the PBM should provide all medications through the pharmacy benefit card provided to the employee. The letter to the employee should detail the safety concerns, as well as highlight the benefits and potential to eliminate waste. In addition, encourage PPOs to create policy forbidding network physicians to dispense drugs.

 

Reasons to avoid physician dispensing:

 

  • Cost of drugs is significantly higher
  • Dispensing from physicians office bypasses all of the safety measures of prospective and retrospective review by the PBM.
  • Misaligned financial incentives for prescribing physician

 

 

Consider Home Delivery For Long-Term Medications

 

Home delivery is the most convenient, safe, and cost-effective delivery channel when an injured worker is taking long-term medications for their injuries. The use of home delivery a successful model that can meet the needs of all interested stakeholders in a workers’ compensation program.

 

  • Insurance Carriers and TPAs: Home delivery meets the needs of this stakeholder by reducing costs associated with pharmacy claims and reducing waste.  It allows for the easy monitoring of what prescription medications are being ordered to avoid issues associated with addiction.  It can also reduce dispensing costs and streamlines billing purposes.  This is especially the case of self-insured employers or those who use TPAs to administer their workers’ compensation programs; and

 

  • Injured workers: Home delivery is the most convenient mechanism for an injured worker to receive their long-term prescription medication.  It is predictable, reduces waste, and utilizes state-of-the-art technology, checkpoints, and automation to virtually eliminate errors that error retail pharmacy.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

WCRI Conference to Highlight Trends, Solutions to Opioid Dependence in WC

“We find extensive opioid prescribing leads to longer duration of temporary disability. When we compare the effect of longer-term opioid prescriptions with no opioid prescriptions, the effect is to triple the duration of temporary disability benefits.”

 

That finding from the Workers Compensation Research Institute highlights the latest trends in the opioid epidemic as it relates to the workers’ compensation industry. It represents the first evidence of a causal relationship between long-term opioid use and disability duration. The authors will be on hand to delve into the research and the topic during WCRI’s Annual Issues and Research Conference in Boston this month.

 

 

Latest Evidence

 

The WCRI researchers looked at data from 28 states for low back pain injuries between 2008 and 2013 where workers had more than 7 days of lost work time. Additional findings were:

 

  1. Local prescribing patterns play a significant role in whether injured workers receive opioid prescriptions. In certain states and particular areas within states, injured workers are more likely to receive opioid prescriptions than in other areas. When they compared injured workers with the same injuries in different areas, they found that a 10 percentage point increase in the local rate of longer-term opioid prescribing was associated with a 2.6 percentage point higher likelihood that a similarly injured worker would receive longer-term opioid prescriptions.

 

  1. Opioid prescriptions persist, despite recommendations against them. While most medical guidelines do not typically recommend prescribing of long-term opioids for low back pain, about 12 percent of WCRI’s sample had them prescribed, and about 39 percent of workers had at least three opioid prescriptions.

 

 

Experts Weigh In

 

In addition to reviewing the most up to date trends, conference attendees will also hear about successful solutions employers are undertaking. The session “Saving Lives—Building a Modern Pharmacy Program amid a Deadly Epidemic” will feature the medical director of the Ohio Bureau of Workers’ Compensation discussing interventions that have had notable results:

 

  • 2011 — more than 8,000 injured workers in Ohio were opioid dependent; meaning they were taking the equivalent of at least 60 mg a day of morphine for at least 60 days.
  • 2017 — by the end of the year, the number was reduced to 3,315.

 

Dr. Terrence Welsh will outline the steps the Bureau took to reduce by 4,714 the number of injured workers at risk for opioid addiction.

 

United Airlines has undertaken various initiatives to curb the misuse of opioids among its injured workers, which will be outlined in a separate session. Joan Vincenz joins a representative from the National Safety Council and another from WCRI to discuss how opioids are impacting the workplace and steps employers can take to mitigate them.

 

A growing interest in medical marijuana and its potential effect on opioid prescribing for chronic pain patients is the focus of a discussion in another session. Dr. David Bradford of the University of Georgia will share results of a new study on drugs used to treat clinical conditions for which marijuana might be a potential alternative treatment.

 

 

The Evolution of WC

 

In addition to the opioid epidemic, the conference also focuses on how the work world is changing and the potential impact on workers’ compensation.

 

  • Will robots take our jobs?
  • Will the workplace be safer with automation or less safe with undertrained independent contractors?
  • How will we insure the new workplace?
  • Will new legal cases arise around independent contractors and on-the-job injuries?

 

Those are among the questions a distinguished panel of workers’ compensation thought leaders will attempt to answer. A representative each from a large employer, carrier, judicial sector, and labor will make their predictions.

 

A longer-term forecast is expected in the session, “Scenarios: Workers’ Compensation 2030.” Former WCRI President and CEO Richard Victor will examine external forces shaping the world and the challenges they pose to the industry.

 

The conference, with the theme “Work and the Comp System: Evolution, Disruption, and the Future,” takes place March 22 and 23 in Boston.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

How Prescription Drugs Impact Your Company and What You Can Do About It

How Drugs Impact Your Company and What You Can Do About ItMore than 70 percent of employers say they have felt the impact of prescription drug usage. That sobering statistic from the National Safety Council highlights the fact that, despite successful efforts by some employers and Pharmacy Benefit Managers to stem the abuse and misuse of opioids and other legal drugs among injured workers, the workplace continues reeling from the effects of legal medications.

 

The NSC’s survey of employers shows there are many areas where employers can take action to address the issue, and for each employee helped, employers can save more than $3,200 annually. Representatives of the NSC, United Airlines, and the Workers Compensation Research Institute will unveil the latest research on how opioids are impacting employers, and the duration of disability for injured workers, during WCRI’s upcoming annual conference.

 

 

Substance Use Disorder

 

‘Substance use disorder’ is the current term to describe the recurrent use of alcohol and drugs that cause clinically and functionally significant impairment, including health problems, disability and a failure to meet major responsibilities at work, school or home. The terms substance abuse and substance dependence are no longer used, according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders.

 

In 2014, there were an estimated 1.9 million people with opioid use disorder related to prescription pain relievers and an estimated 586,000 with an opioid use disorder related to heroin use. There are a variety of symptoms, such as an inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.

 

 

Impact on Employers

 

Absenteeism is cited as the #1 impact of prescription drugs in the workplace, according to the NSC survey. Workers who have substance use disorders miss almost 50 percent more work days than their peers — up to six weeks annually.

 

Using pain relievers at work, having a positive drug test and being impaired or having decreased job performance were also included on the list of ways prescription drugs have impacted companies.

 

‘Near miss or injury’ was named by 15 percent of the respondents as a problem among prescription drug abusers. 84 percent of the employers cited concern over the costs of workers’ compensation because of prescription drug use.

 

Here are some additional findings from the survey:

 

  • 76 percent are not offering training on how to identify signs of misuse.
  • 81 percent lack a comprehensive drug-free workplace policy. Of those that do a drug test, 41 percent don’t test for synthetic opioids.
  • 19 percent feel ‘extremely prepared’ to deal with prescription drug misuse.
  • 70 percent would like to help employees return to work following appropriate treatment.
  • 88 percent are interested in insurance coverage for alternative pain treatments

 

The NSC conducted the survey of more than 500 HR decision makers for companies with at least 50 employees. Looking at specific industries and demographics, the Council said construction, entertainment, recreation and food service sectors have twice the national average of employees with substance use disorders.

 

Industries dominated by women or older adults had a two-thirds lower rate of substance abuse, and industries that have higher numbers of workers with alcohol use disorders also had more illicit drug, pain medication and marijuana use disorders

 

Employers were most concerned about the costs of benefits associated with substance use disorders, and their ability to hire qualified workers. They were less concerned about drug misuse and illegal drug sales or use.

 

The NSC also said that workers who are in recovery have lower turnover rates and are less likely to miss workdays, less likely to be hospitalized and have fewer doctor visits.

 

While 71 percent of employers say prescription drug misuse is a disease that requires treatment, 65 also feel it is a justifiable reason to fire an employee.

 

 

Action Steps

 

Healthcare costs for employees who misuse or abuse prescription drugs are three times higher than for other employees. And the annual cost of untreated substance use disorder ranges from $2,600 to as high as more than $13,000 per employee.

 

The good news is employers can take steps to protect their companies and employees. They include:

 

  1. Recognize prescription drugs impact the bottom line
  2. Enact strong company drug policies
  3. Expand drug panel testing to include opioids
  4. Train supervisors and employees to spot the first signs of drug misuse
  5. Treat substance abuse as a disease
  6. Leverage a best-in-class Pharmacy Benefits Management provider relationship

 

Conclusion

 

Nearly 21 million are living with substance use disorders of one type or another; more than the entire population of the state of New York. Most of those people are employed.
The problem costs the U.S. economy more than $400 billion per year. Employers can play a significant role in reducing this epidemic. In fact, employer-supported and monitored treatment yields better-sustained recovery rates than treatment initiated at the request of friends and family members.

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Arm Injured Workers with Information to Prevent Opioid Abuse

Arm Injured Workers with Information to Prevent Opioid AbuseThey say the best consumer is an informed consumer. This statement is certainly true for injured workers being prescribed opioids.

 

Among the steps that will help curb the opioid epidemic in this country is educating patients. Most people are not fully aware of the effects of these drugs or that they are not the only option for treating pain.

 

“I’ve always felt that if patients knew all the risks, beyond those of addiction, many of them would opt for one of the other therapies,” said Phil Walls, Chief Clinical Officer of myMatrixx. In his webinar series on patient advocacy and opioid therapy, Walls stresses the idea of arming injured workers with full knowledge of the side effects and warnings before starting them on opioids. He suggests providers use information available on the internet from the federal government to begin a dialogue with injured workers.

 

 

Many Risks of Opioids

 

While the risks of addiction, overdose, and death have been well publicized with prolonged use of opioids, there is also the danger of tolerance. Tolerance means the person will need to take more of the medicine to get the same pain relief; and a higher risk of physical dependence, along with withdrawal symptoms is present if the drugs are stopped.

 

There are many other, less publicized risks from opioids. The Centers for Disease Control and Prevention outlines several of them in its Prescription Opioid Factsheet for Providers:

 

  • Increased sensitivity to pain
  • Constipation
  • Nausea, vomiting, and dry mouth
  • Sleepiness and dizziness
  • Confusion
  • Depression
  • Low levels of testosterone that can result in lower sex drive, energy, and strength
  • Itching and sweating

 

The risks are even higher when certain other conditions are present. Sleep apnea, for example, heightens the risk of side effects, as does pregnancy, depression, and being 65 years of age or older.

 

Mixing opioids with other medications can be dangerous or even fatal. A cocktail of benzodiazepines — Xanax or valium — and muscle relaxants should be avoided “unless specifically advised by your health care provider,” according to the CDC.

 

 

Alternatives

 

“Opioids are not the first line or routine therapy for chronic pain,” the CDC explains. Research shows that other medications with far fewer side effects can be as, or more effective for pain relief if taken as prescribed. These alternatives include acetaminophen, ibuprofen, and naproxen.

 

Other non-medicinal treatments for chronic pain include physical therapy, and cognitive behavioral therapy (CBT). CBT is a short-term, goal-directed approach that teaches patients how to modify their thinking and behaviors to manage pain.

 

For injured workers who fail to get pain relief from any other measures and are prescribed opioids, nonpharmacologic therapy, and nonopioid pharmacologic therapy should be combined with them, the CDC advises. Opioid therapy should be considered “only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

 

 

Discussion Starters

 

In addition to the CDC, other government entities also have valuable information available on the web. One is the Food and Drug Administration.

“How does the FDA approach patient advocacy with regard to opioids? They arm the patient with questions to ask their provider,” Walls explains. “This is a very interesting approach because the FDA is empowering patients to take charge of their own care.”

 

The FDA document, What to Ask Your Doctor Before Taking Opioids, can be a great way to open the dialogue about opioids and their alternatives. Among the FDA’s suggested questions are:

 

  1. Why do I need this medication — is it right for me? Topics under this general heading that should be addressed between the provider and injured worker are:
    1. How long do you expect it to last?
    2. What medication are you giving me?
    3. If it’s an opioid, are there non-opioid options that could help with pain relief while I recover?”

 

  1. How long should I take this medication? The FDA suggests patients ask their providers to prescribe the lowest dose and the smallest quantity for the average patient. Walls says providers should be even more vigilant, realizing that many patients are not ‘average.’ “If the patient isn’t average, that average low dose may actually be an overdose,” he says. “The only way to find the lowest possible dose is to start with one less.”

 

  1. Can I have a Rx for naloxone? This medication can reverse the effects of an opioid overdose. Walls points out that only high-risk patients should need this, in which case the provider should consider something besides opioids. Also, the injured worker’s caregiver needs to understand that naloxone takes the patient into an immediate withdrawal situation, which requires emergency care.

 

 

Summary

 

In addition to educating workers’ compensation stakeholders about the risks of opioids, injured workers themselves should be made aware of the facts. Information available on some government websites can help providers be prepared to have honest discussions with their patients.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Leverage Specialty Pharmacy Services in Complex Workers’ Comp Claims

Leverage Specialty Pharmacy Services in Complex Workers’ Comp Claims The increasing use of prescription medications places unique challenges on workers’ compensation programs.  Part of the problem is the complex nature of these issues.  This includes the use of “specialty pharmacy” to address the needs of complex matters.

 

 

What is Specialty Pharmacy?

 

The pharmaceutical business is always changing.  One of those changes is the rise in “specialty pharmacy,” which fills specialized prescription drugs, or those that are needed for small groups of patients with complex, chronic conditions. These prescriptions require additional care in their dispensing, handling, and delivery including patient education and training on side effects and self-administration of drugs beyond what is available at a typical retail pharmacy.

 

Specialty Pharmacy staff including nurses and pharmacists will be trained in complex conditions and treatments to offer patients additional education and resources.

 

 

Specialty Pharmacy and Its Impact on Work Comp

 

According to the latest Express Script’s Workers’ Compensation Drug Trend Report, specialty drugs account for 5.9% of total pharmacy costs, yet account for less than 1% of drugs used by injured workers’.

 

Specialty pharmacies focus on prescription medications that are not commonly used and dispensed.  These medications usually affect high-risk occupations that have unique challenges.

 

Some examples of conditions where specialty pharmacy come into play include:

 

  • Hepatitis C infections;
  • HIV/AID treatment;
  • Various cancers; and
  • High blood cholesterol­­­.

 

 

Common specialty prescription medications used include:

 

  • Harvoni® (ledipasvir/sofosbuvir): Antivirals (hepatitis C)
  • Enoxaparin sodium: Anticoagulants
  • Enbrel® (etanercept): Anti-inflammatories
  • Truvada® (emtricitabine/tenofovir): Antivirals (HIV)
  • Gleevec® (imatinib): Oncology drugs
  • Isentress® (raltegravir): Antivirals (HIV)
  • Xolair® (omalizumab): Asthma and allergy drugs

 

 

Implementing Specialty Pharmacy to Reduce Program Costs

 

Using a specialty pharmacy as part of your workers’ compensation program is essential for any workers’ compensation program administrator who seeks a competitive advantage in complex cases.  Use of this program can drive down costs and maintain a high standard of care for injured workers with the most complex and chronic conditions.

 

In the area of specialty pharmacy, the increasing cost associated with lifesaving prescription medications is primarily driven by two factors: an increase in the average cost per prescription, and increased utilization costs associated with specialty pharmacy medications.

 

Implementation of a specialty pharmacy program should be part of working pharmacy benefits manager relationship with expertise in this area.  Run a pilot program for 60-90 days to evaluate and compare your results to industry benchmarks.

 

 

Conclusions

 

To be successful with complex and chronic conditions, workers’ compensation program administrators and members of the claim management team should be aware of and utilize specialty pharmacies.  This will allow them to properly manage and reduce costs for specialized prescriptions that can cure and relieve the effects of uncommon workers’ compensation injuries.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Gene Therapy Holds Great Promise, But Big Price

Putting new lifesaving medicines within reach requires novel collaboration.

 

In approving America’s first commercial gene therapy – an extremely expensive, but highly effective treatment for the most common type of childhood cancer – the U.S. Food and Drug Administration (FDA) ushered in a “new frontier in medical innovation,” according to a statement by FDA Commissioner Scott Gottlieb.

 

But paying for this treatment, and other groundbreaking gene therapies that will follow, requires new models for collaboration among payers, pharma companies, and pharmacy benefit managers like Express Scripts. We are committed to put these medications within reach of the patients who need them.

 

 

Dramatically Higher Price

 

The newly approved drug, KymriahTM (tisagenlecleucel)‎, manufactured by Novartis, brings hope to the 3,100 people under the age of 20 in the United States who are diagnosed each year with acute lymphoblastic leukemia. The medicine is customized for each individual, using genetically modified versions of the patient’s own immune cells to target and kill leukemia cells. The price is $475,000 – lower than the $600,000 to $750,000 that some analysts expected, but still dramatically higher than other specialty drugs.Gene therapies introduce genetic material into a person’s DNA to replace faulty or missing genetic material that leads to disease. These therapies are administered once, unlike nearly all other medications that are repeatedly taken over time. And therein lies the challenge.

 

Pharmaceutical companies have a single opportunity per patient to get paid. And many gene therapies target extremely rare diseases, so there aren’t many patients to share the cost drug makers require to justify the expense of research, development and commercialization. The result is very high price tags: the first two commercial gene therapies, approved for use in Europe, cost $1.4 million and $665,000. Despite promising clinical results, one failed and the other is struggling to find a market.

 

The health care system isn’t set up for this type of economic model.

 

 

We Need a New Payment Model

 

Express Scripts is working with drug makers, policymakers, patient groups and payers on innovative approaches to make gene therapies accessible for patients. Value-based contracting can ensure that payers and patients aren’t on the hook when a treatment isn’t effective. Consultations involving pharma companies and payers can help set appropriate prices. Discussions with policymakers can help set an appropriate regulatory framework.

 

Ultimately, Express Scripts believes gene therapies will require payment and patient care systems which are as novel as the medications themselves. Ideas on the table include paying for a treatment over time, establishing insurer risk pools and financing one-time payments. A successful model must address patients who change insurers or employers, and tracking their health outcomes over time to ensure payments aren’t being made if the treatment stops being effective.

 

 

Putting Medicine Within Reach

 

The promise of gene therapy is great: Approximately 4,000 diseases are linked to gene disorders, and many lack any effective treatment. More than 1,500 potential treatments are in research and development by dozens of pharmaceutical companies; including nearly 600 targeting cancers and 500 for rare and debilitating or deadly conditions.

 

As these life-saving and revolutionary treatments continue to be developed, it is up to payers, pharma companies and policymakers to unite and ensure they reach patients. Express Scripts stands ready to do its part.

 

 

Author. Steve Miller, MD – Chief Medical Officer, Express Scripts. Dr. Steve Miller’s expertise represents years as a medical researcher, clinician and administrator, and spans numerous healthcare subjects. Since joining the company in 2005, he has represented Express Scripts as a presenter at nationwide conferences. Dr. Miller is currently the company’s chief medical officer and is actively involved in developing our clinical programs and advancing the use of generic pharmaceuticals and specialty medications. He is a leader in the promotion of legislation to create a pathway at the U.S. Food and Drug Administration for the regulation of biogenerics and biosimilars. Prior to joining Express Scripts, Dr. Miller was the vice president and chief medical officer at Barnes-Jewish Hospital, Washington University School of Medicine in St. Louis. He has an MBA from the Olin School of Business at Washington University in St. Louis and a medical doctorate from the University of Missouri-Kansas City.

 

7 Ways to Reduce Your Workers’ Comp Prescription Drug Spend

Focusing on generics instead of brand name drugs, and in-network pharmacies instead of third-party billers are among the ways payers can help reduce their workers’ compensation costs while still ensuring quality care. Taking a deeper look into where and how the industry spends money on pharmaceuticals reveals many additional things organizations can do to eliminate unnecessary expenses for medications.

 

A recent report on drug trends within the workers’ compensation system shows, for example, that brand name abuse-deterrent formulations for opioids cost on average $520.85 more per prescription than non-brand abuse deterrent formulations (ADFs). Even though these medications are not typically included in workers’ compensation formularies (unless by client request), they are having an impact, according to the Drug Trends Report from Express Scripts.

 

Steps to eliminate wasteful Rx spending include:

 

  1. Educate providers and patients about the risks and benefits of opioids, and consider alternatives for chronic pain by using evidence-based guidelines.
  2. If an ADF is requested, consider whether the patient is at risk of abuse when considering whether to approve the medication and if they can use a more traditional opioid. Likewise, if  an overdose antidote is requested because of overdose risk, consider less expensive alternatives to Evzio where possible, such as narcan, naltrexone or naloxone.
  3. Look closely at dermatologicals that are prescribed; consider lidocaine rather than the more expensive Lidoderm.
  4. Closely review prescriptions for compound medications to see if they are truly needed for the patient. Likewise, for physician-dispensed drugs.
  5. Educate and encourage providers to use of generics rather than brand name drugs, where possible.
  6. Avoid third-party billers if possible.
  7. Closely review and watch prescriptions of specialty medications.

 

Below is a look at several categories of medications prevalent in the workers’ compensation system and where payers can reduce their costs.

 

 

Opioids

 

These remain the most expensive and most utilized class of drugs in workers’ compensation, despite industry and governmental efforts to stem their abuse. Express Scripts said they accounted for 26.6 percent of per-user-per-year (PUPY) spend and 24.3 percent of PUPY utilization among its clients. The good news is that spending on opioids decreased last year.

 

Still, more than half of injured workers — 50.9 percent had an opioid prescription last year, and 25 percent of injured workers used them for at least 30 days.

 

Patient and provider education is key to reducing utilization and prescribing of these drugs so that they are used according to evidence-based guidelines in the more acute phases of pain, rather than injured workers with chronic pain.

 

The use of ADFs among injured workers increased by 50 percent from 2015 to 2016. Typically, a payer must approve the medication prior to dispensing due to the cost of the drug and the need to assure that it’s appropriate for the injured worker.

 

If you receive a request for an   opioid overdose antidote, look at the specific drug noted. Several versions are on the market, including naloxone; Narcan®, (naloxone); naltrexone; and Evzio, as self-injectable form of naloxone. It is important to note however, “the average cost per prescription for Evzio was $3,380.69 higher than for Narcan, naltrexone and naloxone combined,” according to the Express Scripts report.

 

 

Dermatologicals

 

Of the top 10 drug therapy classes, the total spend per class decreased on 7 of the 10 classes between 2015 and 2016. Among those with an increase were dermatologicals, which had a spending increase of 1.3 percent. The 10 percent increase in the average cost per prescription was moderated by a 9.5 percent decrease in utilization, according to the 2016 Drug Trend Report.

 

Generic versions of Voltaren® gel helped decrease utilization of the brand name drug, and should be considered by payers.

 

Prescriptions of lidocaine decreased, and the average cost per prescription is almost half that of Lidoderm — a lidocaine patch. Even though Lidoderm only had 4.2 percent of market share in 2016, the cost increased nearly 28 percent from the previous year.

 

 

Compounded Medications

 

Spending on these has decreased considerably in recent years, mainly due to a decrease in utilization. However, these are still seen as a significant cost driver in the workers’ compensation system. Medical treatment guidelines generally do not consider these a first line therapy for conditions typical of injured workers. They are excluded from most formularies and require prior authorization.

 

The cost of compounded drugs “averaged $1,966.92 per prescription in 2016 compared to $1,558.14 in 2015,” according to Express Scripts.

 

 

Physician Dispensing

 

These cost “$109.19 more than drugs dispensed by pharmacies,” the Drug Trend Report said. More than 38 percent of physician dispensed drugs are for pain or pain/inflammation.

 

The top physician dispensed drugs in 2016 according to Express Scripts were meloxicam, cyclobenzaprine, gabapentin, tramadol and Mapap® (acetaminophen).

 

 

Generics

 

Generics are identical in effectiveness to brand name drugs. Nevertheless, prescribers may turn to brand name drugs due to “habit, lack of awareness of available alternatives or patient request,” according to Express Scripts. “Injured workers create waste by requesting brand-name drugs instead of generics. Workers’ compensation payers can create unintentional waste when, to limit potential disruption, they fail to adopt programs that encourage the use of equally effective, lower cost options.”

 

 

Network Pharmacies

 

Prescriptions that are filled through third-party billers or out of network pharmacies “incur additional costs, with no additional value,” according to Express Scripts. The company noted that payers using its network pharmacy system spent 15 percent less than through third-party billers.

 

 

Specialty Drugs

 

These account for less than 1 percent of drugs used by injured workers, however the costs for them can add up. Spending on them increased 3.2 percent in 2016 and represented 5.9 percent of total spending, among Express Scripts’ clients.

 

There was a 46.9 percent increase in spending for the HIV drug Truvada® prescribed for pre-exposure prophylaxis; spending on Xyrem® (sodium oxybate) in the therapy class of psychotherapeutic and neurological agents (anticataplectic agents) increased 68.6 percent; and Xolair® (omalizumab), an asthma medication saw a 64.3 percent increase in spending. Client spend on specialty medications varies, largely dependent on the injured worker population covered by the client.

 

Conclusion

 

Ensuring injured workers get the best medical care for optimal outcomes should not be contingent on spending on unnecessary medications. Payers can control their costs for medications and still provide quality care.

 

 

 

Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center. .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2017 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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