Workers’ Compensation Prescription Drug Spending Decreased 7.6% in 2016

St. LOUIS, Apr. 4, 2017 – Express Scripts (NASDAQ: ESRX) lowered prescription drug spending for workers’ compensation payers by 7.6 percent in 2016, according to the 11th edition of its Workers’ Compensation Drug Trend Report.


“In a year when many payers wrestled with drug price increases that dominated the news, Express Scripts protected clients from this impact,” said Dr. Brigette Nelson, senior vice president of workers’ compensation clinical management at Express Scripts. “By practicing pharmacy smarter, we helped clients balance appropriate care for injured workers while keeping costs down.”



Decrease in Opioid Use Drives Down Trend


In 2016, opioids remained the most expensive therapy class at $391.35 per user per year (PUPY). Thirteen of the top 25 workers’ compensation medications were opioids.


However, for the sixth year, overall opioid trend decreased. In 2016, trend decreased 13.4 percent due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends.


This stark decrease in overall pharmacy trend — heavily driven by decreased opioid utilization — proves key stakeholders are taking action to combat the epidemic of opioid abuse and misuse:


  • Payers: Through point-of-sale programs, physician outreach, patient education and advanced analytics, Express Scripts’ solutions enable payers to combat the safety and cost concerns associated with opioid use from every
  • Prescribers: Scrutiny of opioid prescribing patterns drove the creation of new guidelines from the Centers for Disease Control and Prevention (CDC), as well as the Surgeon General’s Report on Facing Addiction in America.
  • Regulatory: Many states have adopted or are considering formularies, opioid prescribing limits or other medical treatment



Bending the Curve on Compound Spending 


For the third year in a row, spending on compounded medications decreased. In 2016, trend was -28.6 percent. These drugs still remain very costly, yet with a 31 percent decrease in utilization, it is clear that effective management strategies can reduce unnecessary costs and waste associated with more than 1,000 clinically unproven ingredients.



Optimizing the Dispensing Channel


Medication dispensed directly to injured workers by prescribers may result in additional costs as the drugs are typically repackaged or relabeled and often are not subject to the same pricing regulations as those dispensed by a pharmacy. Injured worker safety is also a concern.


“Physician-dispensed medications lack the point-of-sale safety edits which occur at a retail or home delivery pharmacy,” Nelson said. “This puts injured workers at risk for potential drug interactions or duplication of therapy.”


According to 2016 data, the average cost of a physician-dispensed medication was $219.25, compared to $110.16 for a pharmacy-dispensed medication. Express Scripts Workers’ Compensation clients therefore paid an average premium of about $109 for physician-dispensed medications and bypassed pharmacist review at the point of sale.


When prescriptions are filled through more costly channels, such as an out-of-network pharmacy or third-party biller, payers incur additional cost, with no additional value. This results in waste in the healthcare system.


For long-term medication needs, drugs delivered directly to an injured worker’s home cost payers 15 percent less than those purchased from a retail pharmacy, while adding convenience for the injured worker.



Continued Vigilance for Specialty Medication Trends


Spending on specialty medications to treat conditions such as hepatitis C and HIV stabilized in 2016. 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.


“Managing specialty spend requires clinical expertise and strategic guidance,” Nelson said. “Clinicians at Express Scripts and our specialty pharmacy Accredo® have disease-specific experience to ensure safety, promote adherence and provide individualized clinical counseling for injured workers with the most complex conditions.”


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



About Express Scripts


Express Scripts puts medicine within reach of tens of millions of people by aligning with plan sponsors, taking bold action and delivering patient-centered care to make better health more affordable and accessible.


Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy care, specialty pharmacy care, specialty benefit management, benefit-design consultation, drug utilization review, formulary management, and medical and drug data analysis services. Express Scripts also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.


For more information, visit or follow @ExpressScripts on Twitter.


Media Contact:

Ellen Drazen, Express Scripts 314-684-5355

WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis

WCRI Recap – 3 Part Series

  1. WCRI Recap – Impact of Donald Trump and 2016 Election
  2. WCRI Recap: 3 Factors That Most Impact Worker Outcomes
  3. WCRI Recap: Single Biggest Factor To Turn-Around Opioid Crisis


It’s been two weeks since the WCRI Conference recently held in Boston. I’m Michael Stack with Amaxx. Today I want to give you some highlights and recap from that recent conference from the notes that I took and the perspective that I had on it.


The next session that I took some detailed notes on was how are states battling the opioid epidemic. I took a lot of different notes in this session, but Dwight Lovan who was formerly with the Kentucky Department of Workers Comp Claims made one statement that I think is the only statement that really needs to resonate with our industry and with state lawmakers.




Single Biggest Factor To Turn-Around Kentucky Opioid Crisis


We all know, or a lot of people know, that Kentucky was the epicenter of opioid overdose deaths and opioid drug problem, so they took this head on. He talked about really how they addressed it in Kentucky and the progress that they’ve made, which has been significant. He made one comment, and he said, and he kind of almost said it in passing, but I wrote it down and I highlighted it and I starred it and I bolded it, because he said, “The biggest impact and the one thing that they did that made the biggest difference was they required their physicians to check the PDMP data.” They made a mandate that required their physicians to check the PDMP data. If you’re not familiar with the prescription drug monitoring program it’s a database that basically doctors can check. It takes maybe 5-15 seconds to see what other drugs that injured worker is taking so they don’t overprescribe, so prevents doctor shopping. A lot of those biggest challenges that cause overdose deaths, so they made a mandate that required the physicians to check this PDMP data before they prescribe the drugs.


That made the biggest impact at the epicenter of opioid overdoes deaths and the significant progress that they have made. I checked this research. I researched it a little bit online. I’m not sure how accurate this data is, but it said 16 states have since implemented this mandate and it should be implemented in every single state, in all 50 states. If this made the biggest impact at the biggest problem area in our country, it’s an easy fix and it only takes five to 15 seconds to save a life, so hugely important point on this how states are combating opioids. If you have not implemented this in your state talk to our lawmakers. Let’s make this mandatory across the board.



Non-Pharmalogical Treatment of Pain


The last session was non-pharmacological treatment of pain as alternatives to opioids. This was a fantastic session. The information covered was very impactful and very moving for the results that it can give for each individual injured worker.


Dr. Dawn Ehde and I apologize because I’m probably pronouncing that wrong, from the state of Washington. She gave a tremendous presentation. Here’s the highlights of what she covered. She covered the idea that this medical model, or the currently medical model as far as the treatment of pain. It just doesn’t work. It doesn’t work because the biopsychosocial factors in all the different elements that go into how an individual perceives their own pain. This reinforces that idea of the do you think you’ll be back to work in four weeks. It reinforces that same idea, the perception of that individual person is such a huge factor on how well they’re going to do, and a huge predictive indicator of how well that claim’s going to go.


She talked about some of the current different options of what’s currently being used out there today. She talked about cognitive behavior therapy and she talked about mindfulness, so two different popular options which you may or may not be familiar with. What she went into a more detail, which I thought was extremely interesting and compelling was this idea of collaborative care. That’s what I want to cover here today.



Collaborative Care Model


It’s very much in sync with the best practice that I recommend, which is the weekly claims round table. It’s about looking at an individual claim, bringing in perspective some different experts to collaborate and come up with the best solution for that individual person because the solution for Tom’s going to be different than the solution for Sally is going to be different than the solution for Joe. Each individual person needs their own path and their own direction. You get the perspective from different experts to work together, collaborate for that outcome. That was really what she reinforced here.


She drew out this picture of the injured worker really being at the center of this model. You’ve got the providers up here. You have a care manager down here, and over here you have what she called consultants, and these consultants and everyone ties into here to service the injured worker. These consultants are psychiatrists, they’re different experts that can bring in and share some expertise with this care manager and with this provider to all work together to collaborate on the different elements that maybe needed to suit that person’s needs, to meet them where they are, to move them towards this positive outcome.


I’m oversimplifying this conversation, I’m oversimplifying this presentation, but you get the idea of what we’re trying to accomplish here and what she’s talking about and how they’re addressing this in the state of Washington to hopefully provide a model for the rest of the country to follow for these outcomes. The idea is to collaborate, connect with this injured worker regularly, have conversations with him, set those expectations. We talked about that in the worker outcome studies of how trust is such a huge factor so you build this huge level of trust with this care coordinator and they’re talking to them, that injured worker, about their expectations that do you think you’ll be back to work question is a huge factor in how they’re dealing with their pain, and how they’re going to recover.


They implemented, they haven’t done a ton of studies on this idea yet, but they implemented in a case of multiple sclerosis patients. There was 188 patients and it achieved what the medical community deems is the triple aim, which is better outcomes, lower cost, and higher satisfaction. That was the only study and they’re starting to roll this out in work comp, so very exciting for the solutions that can be brought to the table. Very impactful, very practical information as always from the WCRI Conference. I hope that you can take this information and put it into practice today.



Pick One Idea & Implement!


My recommendation is to start with one thing, start with one thing. What is it from that conference that you want to implement today and build that momentum, which is how significant change happens. Again, I’m Michael Stack with Amaxx, remember your success in Workers Comp is to defined your integrity, so be great!




4 Questions On Urine Drug Testing To Deliver Better Work Comp Outcomes

Urine drug testing (UDT) is one of the more controversial and misunderstood tools in the workers’ comp system. While medical guidelines support the tests for injured workers who are prescribed opioids, stories of over testing injured workers —and overcharging payers — abound. There are also questions about what type of testing to use, the frequency of the tests, and what to do with the results.


UDT used judiciously and paired with clinical expertise can be invaluable in ensuring injured workers get the right medications at the right time. Understanding some of the basics will help you get the best bang for your UDT buck.


Types of testing


  • Forensic. UDT has been around for decades, beginning with its use to identify illicit drug users in criminal and civil proceedings as well as the workplace. This forensic, or ‘gotcha!’ model is designed to determine yes or no that someone is taking certain, typically illegal drugs. An initial screening — presumptive — test is performed and any positive results are sent for confirmation. The types of tests include in-office point of care. Results from these tests can come in minutes. However, they are not necessarily designed to detect the use of medications at therapeutic doses, something critical in a clinical setting. Also, the tests are not available for all drugs, such as synthetic drugs of abuse. Since oxycodone is a semi-synthetic opioid, it may not always be detected in these tests.
  • Clinical. This model puts the focus on the patient-provider relationship and is used as part of patient care in various settings, including pain management. The idea here is to identify the presence of specific prescribed medications, non-prescribed medications and illicit substances to benefit the therapeutic goals of the patient. Definitive testing, typically used in this model, provides information about specific drugs and metabolites and can detect drugs at much lower concentrations, which presumptive tests do not. The results of these tests, however, may not be available for 24 hours or more.


The type of test used for an injured worker depends on a variety of factors, including the physician’s assessment of the patient’s risk. The types of medications also has a bearing on the most appropriate tests. If there are multiple opioids, for example, presumptive tests may not provide enough information to help the physician.


Why Test:


Guidelines published for prescribing opioids to injured workers support the use of UDT to help identify safe and effective treatment options.  Some of the reasons to undertake UDT include:


  • Risk assessment. Research shows many prescribing physicians are not aware of their patients’ past and current drug-taking behavior. Clinical UDT provides clear evidence of the patient’s drug taking behavior, which is vital to the provider’s treatment plan, risk assessment, and interaction with the patient.
  • Clarification. In addition, patients often do not know specifically which drugs they are taking. So the drug test can add to the provider’s understanding of the patient’s current medical treatment.
  • Data consistently shows about 18 percent of workers’ comp patient samples do not indicate they are taking the prescribed drug. Given the problems with diversion, misuse, and abuse, it is clear that workers’ comp patients may be complicit — wittingly or not — in the inappropriate consumption of prescription drugs.


How Often to Test


How often should an injured worker on opioids be monitored through UDT? This is one of the key questions and problems surrounding UDT. Too much testing is a waste of money, while too little testing may lead to missed opportunities for intervention and cause the claim to deteriorate.


Physicians can determine how often UDT should be conducted based on the injured workers’ risk of medication misuse, abuse or diversion; and the importance of adherence, such as if the injured worker is being weaned off certain drugs.


  • Low risk. Injured workers who have little to no risk should be tested annually.
  • Moderate risk. Injured workers who have some red flags indicating they are potentially at risk should be tested a few times per year.
  • High risk. Injured workers with a high propensity for medication abuse should be tested frequently, in some cases even monthly.



What to Do With The Results


One of the problems with UDT is the lack of follow through after an unexpected or inconsistent test result. Faced with evidence that the injured worker is not taking her medications as prescribed, and/or is taking medications that were not prescribed — including illegal substances — some intervention is necessary. The results may be a clue that the injured worker is getting medications from more than one provider. At the very least, the provider should discuss the results with the injured worker. Unexpected results occur on average more than half the time.


Once the test results are available there are several steps that may be beneficial.


  • Work with a PBM. A pharmacy benefit manager can help interpret the test results and provide guidance on what the next steps should be. An unexpected test result may be due to a variety of factors; such as drug-drug interaction, or a contaminated or diluted sample. The answer is not always black and white, and a PBM or other expert can help decipher what the results actually mean.
  • Additional clinical outreach.
  • Follow-up testing.
  • Peer-to-peer review.
  • Change in medication therapy.




UDT can provide much needed information to help guide a claim. However, it should be part of an overall strategy and not the only tool used. It’s important to know the benefits and limitations of UDT and use it to help understand the whole picture of the injured worker.



For additional information on workers’ compensation cost containment best practices, register as a guest for our next live stream training.


Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices.



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©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.


Opioid Addiction: The Painful Reality

For years, Express Scripts has been committed to managing concerns about long term opioid use, especially the risk for addiction.


new report from the U.S. Surgeon General highlights the rise of addiction to drugs and alcohol and calls for a deeper investment in pain management strategies. This first-ever report intended for health care providers, law enforcement, and policy makers focuses on numerous prevention and treatment methods available and the vision for a future with reduced stigma on alcohol, drugs and addiction.


The SAMHSA (Substance Abuse and Mental Health Services Administration), a federal agency charged with advancing the behavior health of the nation, contributed much of the data and analytics.


In 1964, a similar in-depth and prescient report regarding tobacco use is now considered to have been the catalyst for change in that industry, and many hope for a similar result from this Surgeon General report.



Express Scripts Commitment


For years, Express Scripts’ workers’ compensation team has been committed to managing both the clinical and cost concerns with long-term opioid use, especially the risk for addiction.


We have continued to build proactive solutions to address the issue from multiple angles. These solutions are focused on helping payers, physicians, risk managers and injured workers arm themselves with tools to ensure safe and cost-effective treatment.


Enhancements to the Express Scripts’ workers’ compensation program offering over the past year have focused on proactive intervention. New in 2016, ScriptAlert+SM, a bundle of point-of-sale edits can be used by workers’ compensation payers to review high-risk prescriptions before the injured worker leaves the pharmacy. This point-of-sale review is carried out in real-time, using OASIS – Express Scripts’ real-time connectivity platform, at the time that a prescription is submitted for filling at a pharmacy. In tandem with the Morphine Equivalent Dose program, Express Scripts proactive opioid programs attempt to tackle the potential of opioid addiction before it begins.



Looking Forward


Just as the Surgeon General calls for more advanced tactics to managing pain, we continue to evolve our solutions. We know that traditional opioid abuse programs identify suspicious activity that’s already happened – by which time behavior modification is extremely difficult. Looking forward, we’re leveraging our advanced analytics to identify and assign risk scores among patients, pharmacies, and even prescribers.



Author Brigette Nelson, MS, PharmD, BCNP, Senior Vice President of Workers’ Compensation Clinical Management, Express Scripts. In this role, Brigette provides strategic oversight for clinical programs for workers’ compensation PBM clients and leads a team of clinical pharmacists and technicians, with client-facing responsibilities for clinical program offerings. She also partners with the workers’ compensation product group in managing clinical programs and consults with clients regarding clinical outcome trend analysis to manage drug spend and appropriate therapy.

America’s Pain Points

a-nation-in-pain-thumbnailExpress Scripts’ newest report, A Nation in Pain, provides a comprehensive examination of the trends in use of prescription opiates in the U.S.


America claims less than 5% of the world’s population, yet it consumes roughly 80% of the world’s opioid supply. Knowing the potential for misuse of these medications, and facing an increase in opioid-related deaths in this country, we wanted a deeper understanding of how patients in the U.S. are using these medications so we can identify additional ways to protect them from the risks associated with their use.


In A Nation in Pain, our research revealed a drop in short-term use of opioids, and stabilization in the number of patients using these medications longer term, which is in contrast to the increases seen in the past. Both trends indicate that doctors are being more cautious about prescribing these pain medications.


However, the research uncovered some concerning increases in the amount of prescription opioid medications Americans use, and the frequency in which these medications are used in dangerously high doses and in risky combinations with other medications.



Prescription Opiate Trends Increase Potential for Abuse


Nearly 60% of patients taking opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period. Two-thirds of patients using these medication mixtures were prescribed the drugs by two or more physicians, and nearly 40% filled their prescriptions at more than one pharmacy.


Among those taking dangerous drug mixtures last year:


  • 27% were taking multiple opiate pain treatments simultaneously.
  • Nearly 1 in 3 patients were on an opiate and benzodiazepine (an anti-anxiety medication), a combination that is the most common cause of multiple drug overdose deaths.
  • Approximately 28% took both a prescription opioid and a muscle relaxant, and 8% were combining an opioid, muscle relaxant and a benzodiazepine. Opioids, muscle relaxants and benzodiazepines all have sedating effects and can slow down the respiratory system. Taking these medications together could increase these reactions exponentially.
  • Women accounted for nearly two-thirds of those taking these potentially hazardous mixes of medications.


Although there could be instances in which prescribing an opioid in combination with these other medications is appropriate, evidence of this concurrent use at such a large scale – and involving multiple prescribers and pharmacies – indicates there could be a breakdown in communication among a patient’s care team or potential abuse.


Also concerning was the discovery that nearly half of patients who took opiate painkillers for more than 30 days in the first year continued to use them for three years or longer. In addition, almost half of chronic opioid users took only short-acting medications – rather than longer-acting formulations – thus increasing their risk for addiction.



Prescription Opiate Use Most Prevalent in Southeastern Small Cities


According to the report, the number of Americans using prescription opiates declined 9.2% in the past five years, yet both the number of opioid prescriptions filled and the number of days of medication per prescription rose more than 8% between 2009 and 2013.





Of the 25 cities with the highest prevalence of longer-term opioid use, 24 have populations fewer than 100,000. On average, 3.9% of Americans were using prescription opioids on a longer-term basis in 2013; in small cities, that average is significantly higher at 5.1%


Among small U.S. cities with fewer than 28,000 residents, the top five had between 12.3% and 18% of their population using prescription opioids and were located predominately in Alabama, Arkansas, Georgia and Kentucky.








Express Scripts Protecting Patient Safety and Preventing Abuse 


Prescription opioids can provide patients with clinically safe and effective pain management. However, the potential for misuse and addiction requires vigilance and exemplary coordination of care.


When patients use home delivery to fill their prescriptions through the Express Scripts Pharmacy, they are cared for by specialist pharmacists with advanced training in pain treatments who can identify cases of suboptimal pain management and help patients use opioids safely and effectively. A subanalysis of the research shows that when compared to those who filled their prescriptions at a retail pharmacy, 23% fewer patients who filled their medication through the Express Scripts Pharmacy were using a potentially dangerous combination of medications, and 15% fewer patients were prescribed medications by multiple prescribers.


Express Scripts’ Fraud, Waste and Abuse program identifies potential cases of drug abuse, conducts extensive investigations and recommends interventions where necessary. The rate of concurrent use of potentially dangerous medications was 7.6% less in patients whose benefit plan was enrolled in the Express Scripts Fraud, Waste and Abuse program in 2013 compared to patients whose benefit plan was not enrolled in the program.



Research Methodology


For the report, Express Scripts examined 36 million de-identified pharmacy claims of 6.8 million commercially insured Americans of all ages who filled at least one prescription for an opioid to treat acute or longer-term (nonacute) pain from 2009 through 2013. Prevalence, use and costs were evaluated during the five-year study period, including assessments of trends according to age, gender and geography. The research also looked at users prescribed opioids in combination with other medications.



dr-nowakAuthor Lynne Nowak, MD, Express Scripts. Dr. Nowak is the Medical Director for the Express Scripts Lab, where she closely collaborates with the Express Scripts Personal Health Solutions team and Therapeutic Resource Center (TRC) specialist pharmacists, researchers and decision designers to implement programs and protocols to continually improve health outcomes for members. She received her internal medicine training at the Mayo Clinic and her medical degree at the University of Illinois. She practiced as a primary care general internist, an academic hospitalist, director of a hospitalist program and medical director of a nonprofit hospice organization. She sits on the Board of  Trustees of the Illinois State Medical Society and the Medical Services and Governmental Affairs Council.

Chronic Pain: A Double Dose of Trouble

chronic-painDealing with “chronic pain” is an issue the workers’ compensation claims management team deals with on a daily basis.  This is highlighted by the daily dose of news about the prescription drug epidemic and the countless Americans who are either addicted to these legal medications, or become addicted to street drugs as the result of using them to deal with work-related injuries.  It is important to claim handlers to be proactive on this issue for the benefit of the injured employee and the bottom line.



What is Chronic Pain?


From a clinical standpoint, “chronic pain” is pain symptomology that lasts from three to six months following the onset of injury.  This can be the result of a specific incident such as a slip/fall injury, an aggravation or acceleration of an underlying condition or an injury resulting from workplace exposure or repetitive activity.


In most incidents, healthcare professionals in the United States deal with chronic pain by prescribing opioid-based pain medications.  These medications come in many forms and names people have come to know.  They include:


  • Codeine (available in generic form)
  • Fentanyl (Actiq, Duragesic, Fentora)
  • Hydrocodone (Hysingla ER, Zohydro ER)
  • Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)


These prescriptions are useful as they relieve pain for a period and allow a person to recover from injury.  They are derived from opium, which is commonly processed into the street drug known as heroin.



Quick Facts on Opioid Addiction


  • From 2000 – 2013, the drug screening industry grew by $1.2 billion.


  • Workers’ compensation insurers in California alone spend about $100 million per year for opioid-based pain medications.


  • Prescriptions for buprenorphine and naltrexone—two drugs used to treat opioid addiction have risen to nearly 8 million in the last number of years.


  • At least 20 states allow doctors to both prescribe and sell drugs, often at dramatic markups.


  • Prescription drugs dramatically increase the cost of a WC claim:
    • $13,000: Average cost of a claim without opioids
    • $39,000: Average cost of a claim with Percocet
    • $117,000: Average cost of a claim with long-acting OxyContin



Issue Identification and Practical Solutions


Members of the claims management team are on the front lines of the battle against chronic pain and its “tax” on workers’ compensation programs.  Claim handlers can look for patterns and help identify issues early on before it becomes a larger problem.  This can especially be the case if a claimant overdoses as part of their medical care and treatment related to a work-injury.  If the death is related to the injury, the cost of the claim increases in the form of death benefits.  Fraud, waste and abuse are other drivers.  It is recommended to leverage a Pharmacy Benefit Manager relationship to help manage both cost and utilization of prescription drugs.


Key signs a claimant is abusing their prescription medications include:


  • Prescription medications that are often lost or stolen. In most instances, they are being sold to a third party or being given to family members.


  • Increasing use of pain medications without subjective reports of improvement. This information can be obtained from a claimant’s medical records and pharmacy receipts.  Information can also be gleaned when speaking to a claimant regarding issues concerning the injury.


  • Use of multiple doctors or pharmacies to obtain pain medications. While most states have pharmacy-reporting programs in place, it is still easy for people to game the system and obtain prescriptions from multiple sources.


  • Resistance to treatment agreements that include random urine samples or treatment plans.





Members of the claims management team play a necessary role when dealing with chronic pain.  This is an important function as monitoring this issue can help contain costs, while at the same time reduce unnecessary expenditures in any workers’ compensation program. A best in class Pharmacy Benefit Manager relationship should be leveraged to successfully manage chronic pain.



Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact:



©2016 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.


Chronic Pain Management: 3 Tips to Help Injured Workers Avoid Opioid Addiction

Jennifer mcgregor articleManaging chronic pain with today’s medical advancements can mean a very high risk of addiction to opioids, found in most prescription pain medications. In the US, use of opioids such as morphine, oxycodone, and hydrocodone, all of which have a high potential for addiction, has grown in recent years. Of course, for many people, life without a pain management plan is simply not feasible. Given the necessity of pain management, here are a few ways you can work to prevent addiction.



Ask for Small Doses


Tell your doctor that you are worried about the risk of addiction down the road, and ask if it would be possible to receive small, frequent prescriptions. Possessing only a small amount at a time with no excess removes much of the temptation and possibility for misuse. You will want to ensure that you have just enough medication to last until the next refill, meaning you are far less likely to take more than you need.



Have a Trusted Loved One Hold Your Medication


If you simply do not trust yourself enough to stay on track with your dosage, have a spouse or a trusted loved one keep the medication in an undisclosed location that you’re not likely to find. They will need to accept the job of dispensing the proper dosage, keeping track of when you are allowed your next dose.


Having someone you trust dispense your pain medication can prevent addiction, overdose, and unintentional mixing of substances. However, it is important that you are upfront with your loved one, fully disclosing the responsibility of their task.



Seek Alternative Treatments


For some chronic pain, it is possible to remove pharmaceuticals from the equation. Instead, you may want to test some up and coming alternative methods for pain management. A few popular options are exercise, reconfigured diet, and herbal remedies.


Yoga is an ideal way to start using exercise to treat chronic pain. It focuses on both strength and flexibility for the entire body while including the added benefit of meditative practice. Exercise can work against chronic pain by strengthening muscles and joints while aiding the nervous system in relaxing, thereby preventing flare-ups.


Diet also has a huge role to play in pain management. Inflammation is often the cause of chronic pain, meaning by incorporating more anti-inflammatory foods, you can reduce your pain. A few examples of these foods might be salmon, dark, leafy greens, bright peppers, and almonds.


Herbal remedies are also rising in popular treatment plans. Some herbs are a great, non-addictive way to reduce inflammation and dull pain. Some options might be turmeric, ginger, and Holy Basil tea, all readily available at the local grocery store.


Preventing addiction in those with chronic pain can be difficult, particularly if the chronic pain is not treatable with alternative options. If possible, weaning yourself from the pharmaceuticals is the best way to avoid addiction. However, when that is not a possibility, reach out to loved ones. Preventing addiction on your own can be difficult and having your loved ones nearby and aware of your situation is the best way to keep yourself honest. Also, keep in mind that addiction is not a guaranteed outcome. Plenty of people around the world take these medications on a long-term basis to treat their pain without it impacting their daily life. Though pain is not a sure-fire path to addiction, you should still be aware of and take steps to minimize your risks.



Jennifer McGregor is a pre-med student at the University of Michigan. She helped create with a friend as part of a class project. With it, she hopes to provide access to trustworthy health and medical resources. Contact:

Stopping the Opioid Drug Epidemic In Workers’ Compensation

pillsThe opioid-based drug epidemic is causing havoc across the United States.  It is also leading to increased costs in workers’ compensation programs and is a main driver in negative patient outcomes in our healthcare system.


The cost of this epidemic affects not only injured workers, but also employers and their bottom line. In fact, at least $60 billion is lost every year due to decreased productivity. It was reported in the 2015 Express Scripts Workers’ Compensation Drug Trend Report the average cost to workers’ compensation payers per opioid prescription in 2015 was $154.66


The stakes are high.  Now is the time to take action.



Treating Chronic Pain in the United States


The term “chronic pain” can have different meanings to patients, caregivers and prescribers. This has resulted in a common misunderstanding of what type of pain meets this definition and how to best treat it.


According to the National Institutes of Health, chronic pain is defined as pain that lasts more than 12 weeks following an injury. This pain can be the result of any type of incident and the level of severity is subjective and unique to the individual. For many years, the primary goal of therapy was to relieve pain and there was an emphasis on escalating doses of opioid-based medications as a mainstay of treatment. This has led to an over-use of opioid-based medications to treat pain beyond the recommend acute phase of care, often without a documented improvement in the patient’s function. Notably, roughly 6,600 people in the United States become addicted to medications intended to treat chronic pain every year.


In late 2015, the Obama Administration took steps to address this pressing issue. It was suggested that the medical community take a fresh approach to treating people suffering from pain, including individuals receiving care following work-related injuries. This approach includes both pharmacologic and nonpharmacologic methods to address pain, as well as a specific focus on guidance for prescribing opioids. An additional focus of this new approach included the use of medication-assisted treatment to avoid dependency issues if use of opioids becomes problematic.



Team Efforts in Combatting Opioid-Based Drug Abuse


Everyone involved in the treatment of patients in pain has a role when it comes to battling the “legal” drug epidemic in the United States.


Prescribers: The focus of all medical care and treatment should be on improving the patient’s functional ability post-injury. This includes the establishment of pain-management goals and promoting healing and the avoidance of merely masking pain. This is a delicate balance that must be struck to ensure adequate pain relief for the patient, yet not promoting reliance on opioid analgesics.


Payers/Employers: There has been a concern within the insurance industry regarding the reliance on Schedule II and III controlled substances for pain relief. Members of the claim management team play an important role as they monitor medical claims and urge compliance with applicable workers’ compensation treatment parameters. They should also ensure that claimants are receiving the care they need, including nonpharmacologic therapy. They should also address the issue of possible abuse as it arises and provide treatment where necessary.



Solutions to Avoid Abuse


In order to address the opioid abuse epidemic in this country, it is recommended that payer organizations partner with a pharmacy benefit manager (PBM) to monitor opioid utilization and detect potential instances of abuse among a patient population. Through a PBM, proactive prescription monitoring is enhanced through various comprehensive tools and triggers at the pharmacy. Your PBM should offer multiple point-of-sale programs that detect opioid utilization and allow payers to make real-time decisions on whether patients can obtain opioid medications from the pharmacist based on various criteria. Solutions to detect fraud, waste and abuse, as well as educational outreach to physicians and patients are also critical components.


It is also recommended that prescribers and pharmacies leverage the data found in prescription drug monitoring programs (PDMPs) prior to prescribing opioids. Prescribers should perform appropriate risk screening for substance abuse and use opioid contracts with clear expectations for prescribing opioids and urine drug testing.





The battle against the abuse of opioid-based prescription medications needs to be taken seriously. Failing to do so impacts injured workers and their employers. Interested parties need to take a proactive approach and seek out unique tools to reduce negative outcomes due to opioids in workers’ compensation claims.



Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact:



©2016 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.


Stopping Opioid Abuse Through Effective Communication

The main driver in the cost of workers’ compensation claims remains the medical aspects of the claim.  This is due in part to the use and overuse of prescription drugs—mainly opioid-based narcotics.  It is important for members of the claim management team to address this issue and adopt best practices to reduce their overall exposure.



How Bad is the Problem?


From 2000 to 2013, services used to screen for substance abuse in the United States grew by over $1.2 billion.  While some of this growth was the result of alcohol abuse, experts estimate a majority of it was due to the use and overuse of prescription drugs.  One significant source of abuse cited by claims and medical professionals was opioid-based prescription medications in workers’ compensation claims.


This overuse is taxing on the workers’ compensation system.  Insurers are spending an increasing amount of time and money to pay prescription drugs to stop this epidemic from spreading.  In the state of California alone, it is estimated that over $100 million per year is spent to fund the drug component portion of claims.  Workers’ compensation insurers are also spending scarce resources to pay for prescriptions for buprenorphine and naltrexone, which are two drugs used to wean an individual off these potent prescription drugs.


Prescription drug abuse is dramatically increasing the cost of workers’ compensation claims.  An example of this impact is as follows:


  • $13,000: Average cost of a claim without opioids;
  • $39,000: Average cost of a claim with a short-acting opioid, like Percocet; and
  • $117,000: Average cost of a claim with long-acting narcotic, like OxyContin



Combatting the Prescription Drug Epidemic


Members of the workers’ compensation claim management team are on the front lines fighting the prescription drug epidemic in the United States daily.  Failure to be effective in this battle can lead the following consequences:


  • Increased costs from prolonged disability and medical care and treatment;
  • Increased case valuation and settlements, which rapidly deplete reserves;
  • Increased possibility of claimant death and drug overdoses, including street-drugs.


The stakes are high. It is important for members of the claim management team to evaluate the following case characteristics:


  • Age of the claimant: Is tolerance going to be an issue?
  • Underlying pathology: Possible chronic pain with low pathology?
  • Chemical Dependency: Denial of some claims and urine screens are necessary.
  • Functional Ability: “Couch Potatoes” beware!
  • Other Long Term Goals: Brief use of opioids to facilitate rehabilitation and then tapered use; and
  • Other Issues: Personality disorders, psychological/psychiatric issues



Results Through Education & Communication


Effective claim management teams cannot win this battle alone.  In order to be effective and remain competitive, these teams should look to outside service providers for help in educating relevant stakeholders.


Best practices dictate partnering with a Pharmacy Benefits Management company that holds the proper expertise and authority to effect change.  The first step is education of relevant parties through communication.  This includes the following:


  • Educate and communicate directly with injured workers about the importance of safe treatment;
  • Communication and letters to doctors on behalf of the claim management team explaining legitimate concerns regarding opioid based prescription drugs; and
  • Bulletins regarding the dangers of physician dispensing.



Example – results of these systems of communication create staggering results:


Express Scripts saw a reduction of nearly 11% in utilization of opioids among their workers’ compensation clients in 2014. Additionally, the  percentage of injured workers using opioids for a longer term (i.e., more than a 30-day supply) decreased 2.6 percentage points in 2014, to 31.5% of opioid users.


Common belief has been that it would be hard to convince an injured worker to choose a lower-cost alternative because there is no financial incentive for them to do so, as injured workers have no out-of-pocket expense for the treatment related to their injuries. However, Express Scripts’ leveraged expertise in behavioral science to pilot a program that sent injured workers a “social responsibility” letter –  explaining how their prescription drug choices could help control the rising cost of healthcare. Injured workers who received the letter were 60% more likely to choose a generic equivalent.





The claims management team has an important role in stopping prescription drug abuse in the workers’ compensation system.  This includes being proactive and collaborating with representatives from the pharmacy industry to educate everyone.



Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact:



©2016 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.


Reality Check on Generic Prescription Drug Costs

The use of generic drugs in workers’ compensation is an effective and efficient method for controlling workers’ compensation costs.  Notwithstanding recent headlines that suggest otherwise, this continues to be a successful tool in controlling the increase pressures place on programs seeking to remain competitive.



What are Generic Prescription Drugs?


The common perception of generic items being cheap or ineffective is simply not the case when it comes to pharmaceuticals.  When discussing the issue of drugs, it merely refers to a drug product that is comparable to a brand/reference listed drug product in dosage form, strength, quality and performance characteristics, and intended use.


For example, a common brand name drug used in workers’ compensation for pain relief is “Percocet.”  This is merely a combination of oxycodone and acetaminophen.  The generic of this prescription drug has the same molecular combinations, and is required by the U.S. Food and Drug Administration to have the same effectiveness and bioequivalent range.



Are Generic Drug Costs Rising?


Until recently, the conventional wisdom has been that generic drugs are less expensive than their name brand counterparts.  Some examples of this include the following headlines, which has sparked a media frenzy:


  • Why Are Generic Drug Prices Shooting Up?; Forbes, February 27, 2015
  • 5 Reasons Generic Drugs Cost so Much; ABC News, August 20, 2015
  • Rising Cost Of Drugs: Where Do We Go From Here?;, August 31, 2015


The issue of rising generic prices as reported in the media is due primarily to two main drivers: a consolidation of companies who manufacture these drugs and a short-lived shortage of active ingredients necessary to make the medications.  While it is true that the price of select generics has increased, the reality of the situation is not what one would think.  As a whole, the average price of generics continues to be significantly lower when compared to their name brand counterparts.



A Reality Check on Generic Prescription Drugs


According to a data published in the Express Scripts Drug Trend Report, since 2008, the average price of brand name drugs has almost doubled, while the average price of generic drugs has been cut roughly in half.  A clear illustration of this fact is found in their prescription drug price index, which graphs brand name prescriptions and generics in a similar way that the U.S. Consumer Price Index measures changes in the prices paid for a representative basket of goods and services.  At the beginning of 2008, starting from a baseline index of about $100, this survey noted an increase in the average brand name prescription medications cost to $227.39, compared to an increase in inflation to $111.24 in the baseline.  The average cost for generics has dropped from the $100 index in 2008 to $37.13 in 2015.


prescription index graph


Using Generics to Reduce Work Comp Costs


Notwithstanding the media hype and spin, generic prescription drugs remain and effective way to control costs in a workers’ compensation program.  The Drug Trend Report also determined it that for every 1% increase in generic fill rate, a payer can expect to reduce their overall prescription drug costs by as much as 2%.  This is welcome news for most workers’ compensation programs as even a small reduction in costs can free up settlement reserves.





Generic prescription drugs create a win-win in any workers’ compensation program.  In terms of serving injured workers, they provide effective pain relief and efficient medical care.  They also allow workers’ compensation programs to reduce costs and promote efficiency.



Author Michael Stack, Principal, COMPClub, 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 of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact:



©2016 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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