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.

 

 

PREVALENCE OF SHORT-TERM AND LONGER-TERM OPIATE PAIN MEDICATION UTILIZATION

prevalence-of-short-term-and-longer-term-opiate-pain-medication-utilization

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.

 

 

STATES WITH THE HIGHEST AVERAGE PREVALENCE OF OPIOID USE

 

state-with-the-highest-average-prevalence-of-opioid-use

 

 

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.

 

 

Conclusions

 

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: mstack@reduceyourworkerscomp.com.

 

 

©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 PublicHealthLibrary.org with a friend as part of a class project. With it, she hopes to provide access to trustworthy health and medical resources. Contact: jmcgreg@publichealthlibrary.org

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.

 

 

Conclusions

 

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: mstack@reduceyourworkerscomp.com.

 

 

©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.

 

 

Conclusions

 

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: mstack@reduceyourworkerscomp.com.

 

 

©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?; Healthaffair.org, 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.

 

 

Conclusions

 

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: mstack@reduceyourworkerscomp.com.

 

 

©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.

 

Control Opioid Abuse With Morphine Equivalent Dose Program

The use and abuse of narcotics in workers’ compensation has exploded over the past decade, creating skyrocketing costs, along with sharp increases in hospitalizations and death from overdose. Best practices to control opioid overutilization require systems to identify the issues in real time, educate the parties, and have a proven plan to implement steps that will improve the claim outcome.

 

 

The Human Costs of Drug Addition in Work Comp

 

Conservative estimates state that nearly 3 million Americans will become addicted to prescription drugs every year.  The effects of addiction can often create devastating problems in personal relationships, employment difficulties, job loss, financial difficulties, legal issues, and psychological problems. Some of the mostly commonly abused prescription drugs include:

 

  • Central nervous system (CNS) depressants and anti-anxiety agents.  These are drugs used to treat psychological and psychiatric disorders;
  • The most common use of these prescriptions are used to treat attention deficit hyperactivity disorder (ADHD); and work shift-induced sleep disorder.
  • These are a classification of drug based from opium, which treat pain.  Common opioid-based medication used by workers’ compensation claimants include morphine, oxycodone, hydrocodone.

 

 

Using MED Management to Fight Morphine Abuse

 

One innovative concept to battle morphine abuse in workers’ compensation claims is Express Scripts’ Morphine Equivalent Dose (MED) Management program.  This unique idea  has shown demonstrable results.  As reported in the Express Scripts Drug Trend Report, the opioid utilization among injured workers decreased nearly 11% in 2014. It is also cutting costs in claim management programs and helping injured workers avoid problems related to prescription drug abuse.

 

 

What is MED Management?

 

The term MED is a calculation tool used to compare and contrast different pain medications to one another.  These calculations “level the playing field” so to speak when comparing OR converting from one narcotic to another. MED Management is a clinical program to calculate the  narcotic medication’s morphine-like potency, or MED, at the time it is being filled (before it has been dispensed).  This helps reduce the chances an injured worker will become addicted to prescription pain medication, and can be  particularly effective in  preventing overdose in those claimant’s consuming 100mg or more of narcotic pain medications. According to the Washington State Agency Medical Director’s Group (AMDG), patients receiving 100mg or more per day of MED had a nine-fold increase in overdose risk.

 

 

Best practices in MED Management dictate a continuous review of an injured worker’s use of prescription drugs.  When the prescription is presented at the pharmacy, there is an evaluation of the prescription medications a claimant is using.  Certain standards are set that the individual is not allowed to exceed in a given period of time.  If the individual exceeds the pre-authorized MED values, the prescription will not be filled, and will be submitted to the payer for review of appropriateness. The program also offers interested claim management stakeholders mechanisms to conduct ongoing utilization reviews of prescription drugs, which can also assist that person’s medical care management team to provide effective and efficient care.

 

 

The Benefits of MED Management

 

MED Management has countless benefits that provide a “win” for all interested stakeholders in a workers’ compensation claim:

 

  • Injured workers: They continue to receive the medical care and treatment they are entitled to under any workers’ compensation program.  They also receive attention to their needs and assistance in avoiding prescription drug addiction and overdose.

 

  • Insurance Carriers and Self-Insureds: Parties who use this system receive the benefit of a proven program that reduces cost and future exposure.

 

  • Claim Management Teams: Having an ally in managing a workers’ compensation claim is important.  This program provides expertise in a complicated area of the claims process.

 

 

Conclusions

 

The MED Management program can be an effective tool in the effective management of a workers’ compensation claim.  It also allows all parties to receive the benefit of a proven program by reducing the chances of the injured worker from becoming another statistic in the prescription drug epidemic.

 

 

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: mstack@reduceyourworkerscomp.com.

 

 

©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.

Use of Drug Formularies to Reduce Workers’ Compensation Costs

The California workers’ compensation system may soon see some relief from the rising costs of prescription drug use in workers’ compensation cases through the adoption of a drug formulary.  If successful, it may spark a nationwide trend that will allow insurance carriers in more states to push for similar cost saving measures.

 

 

What is a “Drug Formulary?”

 

A drug formulary is a list of prescription medications that practitioners use to identify drugs that provide the patient with the greatest benefit.  They also include a cost-saving element, which is important in the workers’ compensation system.  The medications on these lists are both name brand and generics.  A panel of medical professionals that include doctors, nurse practitioners and pharmacists selects the drugs for inclusion on the drug formulary.  In order to ensure patient satisfaction and cost-effectiveness, these lists are continually evaluated and updated as needed.

 

 

Use of Drug Formularies in Workers’ Compensation

 

Washington, Texas, Ohio and Oklahoma are the only states that currently employ a drug formulary in their workers’ compensation system.  The California legislature recently passed a law that allows for the formation of a drug formulary to be used in its workers’ compensation system by 2017.

 

There are some differences in how these states operate their formularies.  This includes two specific types of formularies.

 

  • Closed Formulary. This type of formulary will include all available FDA prescription and non-prescription drugs.  These drugs are dispensed on an outpatient basis and identifies specific drugs, or drug classifications that required a pre-authorization process or are not covered.

 

  • Open Formulary. This will include all FDA approved prescription and non-prescription drugs with no pre-authorization or coverage barriers.

 

When a drug formulary is developed, it is includes a Preferred Drug List (PDL).  A PDL is a list of drugs included in the formulary that is “preferred” for coverage purposes.

 

Drug formularies typically exclude investigational or experimental drugs and “N” listed drugs, which are not recommended for use.  Like drug formularies for private health insurance plans, the injured worker is required to use medications on the formulary.  If a treating doctor prescribes a medication not on the approved list, exceptions can be made by following specified procedures.

 

 

Benefits to of a Drug Formulary

 

The use of drug formularies in workers’ compensation is a rather new concept so the exact impacts and long-term benefits are unknown.  Drug formularies are common in individual and group health plans, which have proven to be successful in reducing cost to the insurance carrier, yet at the same time making sure the patient receives the quality of care they deserve.  Other benefits include:

 

  • Provide patients with evidence-based outcomes and better results in prescription drug management;
  • Create a consensus on prescription medication treatment and care for patients;
  • Ensure a consistency of medical care and treatment; and
  • Involve a dispute resolution process and expedited appeals.

 

 

Additional Workers’ Compensation Applications

 

The use of a drug formulary can also be used to monitor the usage habits of a workers’ compensation claimant an identify areas of concern.  This can include malingering and use or abuse of opioid-based medications.  Another practical application is the prevention of fraud, waste and abuse in the system.

 

 

Conclusions

 

More states are adopting a drug formulary in their workers’ compensation system.  When used correctly, a formulary can ensure that injured workers receive the medical care and treatment they are entitled to and provide insurance carriers with cost savings.  However, while a formulary does carry many benefits, it is important to recognize it is not a ‘quick fix.’ Employers are encourage to remain actively involved in the process, including the management of a proactive pharmacy benefits management vendor relationship.

 

 

 

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 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 monthly basis 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: mstack@reduceyourworkerscomp.com.

 

 

©2015 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.

The Face and Cost of Opioid Addiction

The face of addiction is often perceived as not a pretty sight. The "normal" people of the world stand in judgment scoffing at what "those" people are doing.  In reality, the face of opioid addiction in workers’ compensation can look just like you, your neighbor, your best friend, or any average employee that had an accident at work. 

 

This honest, “average Joe” employee has never had a major injury, and has never been prescribed narcotics. 

 

 

Just Make the Pain Go Away

 

The pain from the injury is severe, so the treating physician prescribes a powerful opioid.  What the physician doesn’t know is that this injured worker is also facing a number of personal problems above and beyond his injury and has been looking for a magic bullet to make those go away.  Instead of using the opioid as prescribed, he starts to take more of it and more often, sometimes in combination with other medications or alcohol. 

 

When the magic bullet doesn’t work, the patient may tell stories of increased pain to convince the doctor, in good faith, to increase the strength of the pills or to prescribe more of them.  He may start seeing different doctors to obtain more drugs or even get drugs from friends and family.    His focus of recovery from the injury is replaced with a focus on obtaining more of the opioid, even though his problems continue to mount.   If his primary doctor does not continue to prescribe opioids as he requests, he may keep searching for a new doctor until he finds one that does.  This approach will only work for so long, as the injured worker continuously has to increase either the frequency of consumption or increase the potency of the opioid to find that euphoria. His craving intensifies and his motivation changes to seek the drug, even as his life spins out of control. He has become addicted to opioids.

 

 

Average Lost Time Claim with Long Acting Opioid 900% Higher than Without

 

This unfortunate story has become all too common in recent years.  The New York Times published an article on the subject titled “The Soaring Cost of the Opioid Economy.”  While the article does not address the cost within any particular company, the information gives us a scope of the opioid problem.

 

The cost of workers' compensation claims skyrockets when injured employees start using opioids.  The average workers’ comp claim with lost time costs $13,000 when no opioids are used.  When an employee is prescribed a short-acting opioid like Percocet® (oxycodone and acetaminophen), the average lost time claim cost triples to $39,000.  When an employee is prescribed a long-acting opioid like Oxycontin, the average lost time claim costs explodes to $117,000, an increase of 900% over the average lost time claim without the use of any opioids.

 

If an injured worker progresses from patterns of misuse to addiction, the treatment for addiction adds to the overall cost of the worker’s compensation claim.  The opioid addiction may be treated with…additional drugs, buprenorphine and naltrexone, as well as a comprehensive behavioral health and psychosocial model.  The use of buprenorphine and naltrexone has risen from near zero prescriptions in 2002 to nearly 8 million prescriptions in 2012.

 

Overall overdose deaths where prescription opioids were involved have also risen sharply along with the cost.  In 1999, there were 4,030 deaths due to opioid overdose.  By 2010, that number had more than quadrupled to 16,651.

 

 

Real Time Intervention Can Prevent Addiction and Decrease Costs

 

Whether an employer is self-insured for workers’ compensation, or has a work comp insurance company, the numbers clearly show how the cost of opioids can have a significant impact on the employer’s overall workers’ compensation costs.  To avoid the cost and employee health concerns of inappropriate opioid use, the employer or insurance company should utilize a comprehensive set of tools from their PBM to screen for patterns of misuse).  PBM best practices for early intervention screening for opioid utilization patterns should include: 

 

  • Implement real time flagging of inappropriately high doses of opioids with tools like a Morphine Equivalent Dose management program
  • Screen for early refill patterns to identify patients who may be taking medications more frequently or at higher doses than prescribed
  • Limit the number of doctors who can prescribe narcotics for an injured worker
  • Screen for opioid prescriptions from multiple pharmacies

 

 

Summary

 

NCCI research shows that while the number of workers' compensation claims has decreased, costs associated with these injuries continue to increase- especially for those on chronic opioids.  This cost is magnified if the injured worker misuses the medication or becomes addicted.  Aside from the huge cost to payers, addiction is very difficult to treat which negatively impacts the life of the worker.  Best practices to control opioid overutilization require systems to identify the issues in real time, educate the parties, and have a proven plan to implement steps that will improve the claim outcome.

 

 

Author Michael B. Stack, Principal, COMPClub, Amaxx Work Comp Solutions. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com, and Founder of the interactive Workers’ Comp Training platform COMPClub. Contact: mstack@reduceyourworkerscomp.com

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

WORKERS’ COMP TRAINING: https://workerscompclub.com

 

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

 

 

 

 

 

Understanding “Medical Marijuana” in Workers’ Compensation

Over the last several years, more states have adopted laws that govern the use of marijuana for medicinal purposes.  While marijuana remains a Schedule I controlled substance under federal law, more states are considering it for legal use to treat work injuries.

 

 

What Do State Laws Permit

 

There are roughly 23 states that allow the use of marijuana for medicinal purposes.  The laws in these states vary on how they can be used.  In Minnesota, the use of this drug is limited to liquid, pill or vaporized forms.  The smoking of marijuana remains illegal.  In other states such as California, possession of marijuana is limited to a specific number of plants a person may cultivate and otherwise possess, and allows for state issued cardholders to smoke marijuana to treat a medical condition.

 

The conditions for which marijuana can be used also vary from state to state.  Most states allow for it to be used for the following conditions:

 

  • Most forms of cancer;
  • Glaucoma;
  • HIV/AIDS;
  • Tourette’s Syndrome;
  • Amyotrophic lateral sclerosis/Lou Gehrig’s Disease (ALS);
  • Seizures and epilepsy;
  • Severe and persistent muscle spasms;
  • Crohn’s Disease;
  • Terminal illness with a life expectancy of less than a year; and
  • Chronic pain conditions.

 

The use of medical marijuana for “chronic pain conditions” is a contentious issue as definitions or pain varies in each jurisdiction.  The required levels of pain to qualify are often subjective in nature, which can lead to abuse or de facto legalization for recreational use.

 

 

Conflict with Federal Law

 

States that currently allow the use of marijuana for medical (and recreational use) are in conflict with federal law and the Controlled Substances Act, which is found under Title 21 of the United States Code.  Federal law enforcement has not taken dramatic steps for force compliance with federal law.  Under a 2015 federal budget act, the U.S. Department of Justice is specifically prohibited from using appropriations to shutdown state-legal medical marijuana programs.  Notwithstanding this capitulation by federal law enforcement, it is unclear how employers can comply with federal and state workplace safety laws if an employee has marijuana present in their system; even if they are not under the influence of the drug.

 

 

Implications in Workers’ Compensation

 

Most states with legalized medical marijuana are struggling to reconcile these laws with workers’ compensation program stakeholders seeking to promote “drug free” workplaces and other barriers imposed by federal laws and regulations.  One example of this conflict was in New Mexico.

 

In Vialpando v. Ben’s Auto. Services, 331 P.3d 975 (NM Ct. App. 2014), an employer was ordered to reimburse an injured employee for payments made to receive medical marijuana.  According to the court, the Lynn and Erin Compassionate Use Act, in conjunction with the New Mexico Workers’ Compensation Act required employers/insurers to provide “a worker [to] receive through employer reasonable and necessary health care services, which the regulations define to include drugs….”  In this instance, because marijuana was legal for medical use, it was compensable for purposes of workers’ compensation and “reasonable and necessary” medical care.

 

In approving the reimbursement for medical marijuana, the Court also examined a number of public policy concerns raised by the employer/insurer, which included:

 

  • A conflict in federal law regarding marijuana and state legalization for medical purposes; and
  • Workplace safety and concerns regarding employee’s using/being under the influence of controlled substances.

 

Both arguments were rejected by the courts.

 

 

Addressing Concerns Regarding Medical Marijuana

 

The legalization of marijuana presents a number of issues for program managers and other stakeholders in the area of workers’ compensation.  It is important for these parties to remain engaged on this issue and address it within their programs.  It also serves as an opportunity for people to be in contact with the state agencies who administer the workers’ compensation laws and regulations.

 

 

Author Michael B. Stack, Principal, COMPClub, Amaxx Work Comp Solutions. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs www.reduceyourworkerscomp.com, and Founder of the interactive Workers’ Comp Training platform COMPClub. Contact: mstack@reduceyourworkerscomp.com.

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

SALES TO PAY FOR ACCIDENTS CALCULATOR:  http://reduceyourworkerscomp.com/sales-to-pay-for-accidents-calculator/

MODIFIED DUTY CALCULATOR:   http://reduceyourworkerscomp.com/transitional-duty-cost-calculators/

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

WORKERS’ COMP TRAINING: https://workerscompclub.com

 

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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