How You Can Prevent Pain Medication From Causing More Pain

Opioid-Induced Hyperalgesia

 

Anytime I discuss medical issues I always clarify that I am in no way a medical physician.  Whether it is to a claimant, or an attorney, I can only interpret medical in my own opinion based on training and years of experience in this business. I do also clarify to people that I always try to stay up to date on new medical issues, since they can have a direct application on the handling of workers compensation insurance claims. 

 

There has been some talk of late about a new issue involving opiate medications, coined “Opioid-induced Hyperalgesia” or “OIH” for short.  Oftentimes a claims adjuster has a file where a claimant is taking a large amount of opiate medications for pain.  Every time the adjuster reviews the medical records, or talks to the claimant, the injured party seems to be in more pain than before, despite the presence or even increased dosage of strong narcotic medications.  How is this possible?  If Oxycodone is doing nothing for pain control, then what other steps could you take for pain control?

 

In the past, an adjuster worried about narcotic pain medication causing addiction issues, dependence issues, and increased medication tolerance issues. In addition to that, these medications are costly, and they seem to be prescribed on every claim no matter what the severity. But OIH has raised new concerns about longer-term chronic pain issues and what to do before these claims get out of control. 

 

 

The Cause of OIH:

 

The exact cause of why OIH occurs is currently under medical investigation.  The leading theory continues to be the excitation of nerves through chemical pathways by certain types of narcotics.  Research has shown that some narcotics may have a higher propensity to cause OIH than others.  These are mainly known as the “phenanthrene opioid” class of medications, which includes codeine, hydrocodone, oxycodone, and hydromorphone.  In patients where OIH could be the culprit, switching to a non-phenanthrene medication such as meperidine or tramadol often times leads to adequate pain relief, much to the surprise to those involved.

 

In simpler terms, OIH may be caused by the narcotic itself increasing the level of pain that the patient may be experiencing.  Almost out of the blue, this medication that is supposed to be used as a pain reliever is actually worsening the pain, thus requiring larger and larger doses of medication for adequate pain relief.  As these doses increase, so do the risks for the more well-known issues with pain medication which include central nervous system issues, depression, addiction, drug-seeking behavior, and the risk of overdose. Even more, the financial costs of these medications begin to dominate the claim more than anything else, including wage loss.

 

 

What to Watch For:

 

Some common characteristics of OIH include:

 

  • Worsening pain over time despite increased dosages of opiate narcotics used for pain control.

 

  • Pain that becomes more diffuse in and around the area of injury.

 

  • Sensitivity to touch around the injured area specifically.

 

  • Subjective setbacks in the progression to MMI without diagnostic objective findings.

 

 

The Future of OIH

 

Although this is a newer phenomenon, the study of OIH can change the way physicians diagnose and treat chronic pain cases.  To date, if a patient’s pain in not controlled by whatever medication they are taking, it is common to step the dosage up to the next level, and re-evaluate pain at the next doctor appointment.  Because increased doses are used, the patient also has increased tolerance for pain medication, and at that point the dose must increase again. But if OIH were to be present early on, but not addressed specifically, then who knows if that medication would have ever helped this person’s pain, no matter what the dose?

 

There is a large potential for work comp claimants to experience OIH symptoms since narcotic pain relief is often used early on, usually at the first visit to the clinic.  When reviewing your comp files, especially those longer-term files where a person has had chronic pain symptoms of an escalating nature without any exacerbation of the injury, those files should be sent for an OIH evaluation by a medical professional.

 

 

Summary

 

I believe it is a safe assumption that OIH could be responsible for a significant percentage of claims dollars spent within the workers compensation system.  Cost drivers that can occur if this is not diagnosed will be increased medication costs, medication side-effect management, and addiction treatment.  These three issues alone can be responsible for large amounts of money spent on the claim.  The ability to identify OIH very early on in the life of a claim can save massive amounts of claim money, and also benefit the claimant who would not have to deal with the strong side effects of the long-term use of these dangerous medications. The ability to identify and treat OIH correctly will lead to better claim outcomes, earlier returns to the workplace post-injury, and an overall decreased burden on the work comp system as a whole. 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

The Best Tidbits of News From the Workers Comp Community

 

 
Date: August 21, 2012
Time: 11:00 am CST
Duration: 1 hour
 
Employers often think that there is nothing that they can do to control workers’ compensation costs. Many times they don’t know where to start, don’t have the resources to get the job done, don’t have the time to do it themselves or don’t have the staff to support the cost-reduction efforts.  Register Here
 
 
 
The 67th Annual Workers’ Compensation Educational Conference and the 24th Annual Safety and Health Conference are just around the corner. Set for August 19 through 23, 2012 at the Orlando World Marriott, the conference will again focus on the national workers’ compensation and safety industries, serving… Read the Full Post »
 
 
 
Published in Business Insurance, Author Mark Walls, Safety National, mark.walls@safetynational.com
 
One of the biggest cost drivers in Workers Compensation is seemingly “average” claims that take a turn for the worst and result in several years of medical treatment and disability.   Mark Walls, vp of claims for Safety National Casualty Corp discusses the common threads of “creeping catastrophic” claims.  Read Full Article…
 
 
 
Posted by Marianne Cloeren, MD, MPH, FACOEM – Managed Care Advisors
 
The organization Physicians for Responsible Opioid Prescribing (PROP) filed a petition with the FDA to change the labeling for opioid analgesics so that it does not include use for chronic non-cancer pain. They make the excellent point that research is showing lack of effectiveness and high risk. 

Here is more information from the president of PROP, Dr. Andrew Kolodny about this effort:

"I’m writing in the hope that you’ll submit comments to FDA supporting the citizen petition for label changes on opioid analgesics. 

As you may have heard, a couple of weeks ago PROP filed this petition with FDA. This request has received support from members of Congress, including Rep. Mary Bono Mack and Hal Rogers, so we believe that FDA is paying close attention. 

Here’s the link where you can submit Comments:
 
 
 http://www.citizen.org/documents/2048.pdf 

And here’s a press release about the petition that was issued by Public Citizen:
 
 
If FDA implements our request, opioid manufacturers will be prohibited from promoting long-term use of opioids for chronic non-cancer pain and the medical community will be informed that this practice has not been proven safe and effective. We believe that this will help reduce overprescribing of opioids. And since it’s overprescribing that’s harming pain patients and fueling the opioid addiction epidemic, the label change could help bring this public health crisis under control
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

New Opioids Being Developed to Decrease Abuse, Save Work Comp Costs

Prescription Drugs Major Expense in Insurance Claims

 

Recent trends in auditing the expenses within insurance claims point to prescription medication as being one of the major expenses involved in these insurance claims.  Within these costs, opioid pain medications tend to lead the way as some of the most expensive medications out there.  It seems that physicians can be rather quick to prescribe Vicodin and OxyContin for the general strain injury, and of course the prescription of these medications can lead to a ton of problems, namely addiction and overall general misuse, which can complicate a claim tenfold.

 

 

Drug Manufacturers Looking for Answer to Addictive Side Effects

 

Faced with intensive scrutiny, drug manufacturers have been scrambling to come up with alternatives to lessen the side effects of these very strong pain relievers. Probably the most common new tactic being created are ways to “disable” the medication when crushed, so when the actual tablet is tampered with it will lessen the potency, thereby making any misuse less attractive to the drug abuser, which also should decrease the overall street demand for the drug. [WCx]

 

In addition to Vicodin and OxyContin, which have lead the way in the newspaper headlines, insurance carriers started to see an increase in the prescription drug Opana, which generally has effects similar to those of OxyContin.  To refresh your memory, this certain classification of medication is used for treating severe breakthrough pain in acute injuries.  Other medications that have stereotypically had a negative connotation within the insurance claim world include Valium, Xanax, Ambien, and to a lesser extent Ultram, Flexeril, Percocet, and the like.  All will fall within a class of benzodiazepines and/or opioid medication used to treat severe and chronic pain complaints. Certainly when an adjuster sees any of these medications being prescribed, a red flag goes up and the adjuster will start an aggressive track of working with the prescribing doctor in an attempt to try alternative, less addictive medications that may be more reasonable to treat short-term injury pain relief. 

 

Instead of these stronger medications being used very sparingly, and often times very early on in the work comp claim as a means to control pain, it is also becoming more common to see these medications prescribed over and over again, even after the acute stage of the claim has long since passed.  This is when the real cost starts to set in, as you can imagine if a claimant is being prescribed a handful of these medications month after month, and sometimes year after year. 

 

 

Overly Prescribed

 

If a claimant is still complaining of pain and states they are no better, then why are these medications being prescribed again and again?  You would think that if the medication were actually not working, that a change would set in sooner or later, and the doctor would start to try to utilize other means of pain relief such as decreasing and tapering the dose, or switching to anti-inflammatory medications instead of opioids. Sadly, this is not often the case.  You could blame this on anything, maybe sometimes just general laziness of the doctor, but really only the doctor knows the real reason.  This is why adjusters, nurse case managers, and pharmacy benefits managers will intervene early on in an attempt to shift the prescriptions into safer, less expensive waters.

 

 

New Drug Alternatives

 

Whatever the reason, there are a few new drugs being marketed out there that you should be aware of.

 

Butrans—A topical patch that delivers relief for moderate to severe chronic pain.

Abstral—A tablet designed to address breakthrough pain in cancer patients.

ConZip—An extended release tablet engineered to address moderate to moderately severe chronic pain.

Lazanda—Delivered in an intranasal spray also for breakthrough pain in cancer patients.

 

These 4 medications will probably only be the tip of the iceberg.  In the past, I would estimate it to be common to see a new drug or two over the course of a year being introduced to treat pain.  As the negative press continues, I would guess you will start to hear more and more medications branded as the “next greatest thing to treat pain while limiting harsh and addictive side effects.” 

 

In addition to new medication, the FDA is also making pharmacists and doctors work more closely together by having more stringent registration requirements once these drugs are prescribed.  I guess the threat of more paperwork and possible penalties may deter doctors from casually prescribing these strong medications when the common injury presents itself.  Whether or not this will work we have yet to find out. [WCx]

 

 

Summary

 

There is an air of change in the world of insurance claims, with the costs of prescribed medication being the main culprit of overall increased costs of long-term injuries, as well as short-term.  But there are changes being made, and it is important to be aware of these changes and the hopeful cost reductions that they hope to achieve. 

 

Saving money on claims affects us all, since in one way or another we all have to compensate for increased costs in the form of increased premiums across the board, no matter what classification the injury claim may be.  Cost reduction starts one claim at a time.  It is never too late to become involved and make these doctors explain why claimants remain on these expensive, oftentimes dangerous opioid medications in long-term use situations.  Make these physicians defend their actions, and don’t let it pass you by and slip through the cracks.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

The Best Tidbits of News from the Workers Comp Community

Here are the some of the hot topics from the Workers Comp world this week:

 

Teach Your Data To Fight Opiod Abuse

Workers’ Compensation research, networking communities, and press are overflowing with information about Opioid overuse and how it is negatively impacting claim costs and outcomes. Information about the problem abounds. Opioid abuse is clearly recognized as a serious problem in the industry, clearly evidenced by recent research.   Read More…


Rulebook Supplement 2012-13 Available Online

The Texas Workers’ Compensation Rulebook Supplement 2012-03 containing rules adopted by the Commissioner of Workers’ Compensation is available online from the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). The supplement can be printed from the TDI website at http://www.tdi.texas.gov/wc/rules/supplements.html.  See more… Information provided by Downs . Stratford, PC 



Security and Risk Management as a Social Science by Emily Holbrook


Here at the Gartner Security & Risk Management Summit, I sat in on a session regarding human behavior and it’s connection to information security. Tom Scholtz, an analyst with Gartner, started off with a statement many of us know to be true, but often forget.

“The single weakest link in the information security chain still remains the human being,” he said.  Read More…

 

The High Cost of Treating Low Back Pain by Dr. David C. Radford from West Hartford Group, Inc.

According to the American College of Physicians, low back pain is the fifth most common reason for all physician visits in the United States. Approximately one quarter of U.S. adults reported having low-back pain lasting at least 24 hours in the past 3 months, and 7.6% reported at least 1 episode of severe acute low-back pain within a 1-year period. Low-back pain is also very costly: Total incremental direct health care costs attributable to low-back pain in the United States were estimated at $26.3 billion in 1998. It is estimated that the real cost of back pain including the cost of health care and lost production now exceeds $100 billion a year.  

To better understand the role of the nation’s chiropractic physicians in reducing the health care cost of low-back pain, WHG has produced a public service video announcement



Watch the video: http://youtu.be/Wfkg3hTSbDI


News From Lexis Nexis

Fifth Circuit Muddies the Water in Hearing Loss Cases

HEARING LOSS UNDER LHWCA

Stephen Embry

I Can See Clearly Now, Just Can't Hear So Good, by Stephen Embry, Esq. In the study of the law styled jurisprudence, there are many schools of thought. Some students of the law believe that past cases predict the future and that precedent must prevail. In this philosophy, past words have meaning and are the expression of internal logic that controls and instructs us as to how current and future conflicts must be resolved. Others follow another road, believing that past cases are at best examples of isolated arguments that worked in the past and may be instructive of arguments that may be useful in the future. Read More…


DEFENSE BASE ACT BILL

JohnKawcyznski

New Bill Proposes to Exclude Private Carriers from DBA Insurance Market, by John E. Kawczynski, Esq. Congressman Elijah E. Cummings (D-MD), the Ranking Member of the House Oversight and Government Reform Committee, has introduced the "Defense Base Act Insurance Improvement Act of 2012" (H.R. 5891) which would exclude private insurance carriers from the Defense Base Act insurance market. Instead, a new "Government Defense Base Act self-insurance program" would be created Read More…


THOMAS A. ROBINSON TO SPEAK AT NATIONAL WORKERS' COMP CONFERENCE

LexisNexis has partnered with the National Workers' Compensation Conference to create an enhanced legal track for attorneys and other workers' comp professionals.Tom Robinson thumbnailLexisNexis author Thomas A. Robinson will be speaking on several panels, including theFuture of Exclusive Remedy. View the program agenda. Overall, there are 15 members of the Larson's National Workers' Compensation Advisory Board speaking at this event. You don't want to miss this conference! Take advantage of the special discount for all LexisNexis Workers' Compensation Law Community members. Community membership is free at our site.

 

Note: If your company has any developments you'd like to share, please send them to us at: mstack@reduceyourworkerscomp.com

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

 

 

 

 

 

 

5 Ways a Pharmacy Benefit Manager can Control Prescription Costs

 
 
The cost of prescribed drugs, especially narcotic pain medications, is rising in the world of workers' compensation. This cost increase is due to the fact that a drug company is like any other company: When the demand for your product is high, supply lessens, and costs have to increase. And, these medications are not exactly cheap to manufacture. In fact I saw a news report that some cancer fighting drugs are in short supply due to overwhelming demand.
 
 
Think about going to your personal physician for a knee strain you had over the weekend playing football with your family. You probably went to your doctor, and you probably left with a prescription for Motrin buddied up with a short-term prescription for a narcotic pain reliever — even if a cold pack or hot pack and rest would have taken care of the problem. This is the world in which we live. In the past, these pain medications were for extremely acute trauma, such as a car accident or bone fracture. But more and more, medications such as Vicodin, Percocet, Oxycodone, etc are being prescribed for the slightly-above-average diagnosis of lumbar or shoulder strain. (WCxKit)
 
 
Below we discuss five ways you can try to control these associated drug costs when it comes to your workers compensation claims. By no means is this an exact science, but it is certainly one you should look into for help controlling your bottom line.
 
1. Come up with your game plan.

Whether you have five claims a year, or five claims per week, medication cost will be a significant expense of the claim. Many carrier/TPAs are partnering with a Pharmacy Benefit Manager (PBM) to review prescription history and also to provide a reduced cost for medications. These outside vendors attract carrier/TPAs by offering them a discount cost for medications, in exchange for their guaranteed business.

 

Adjusters set claimants up with a drug card from these vendors, and they are widely accepted at many pharmacies nationwide. Furthermore, the PBM will review the injury and the claimant’s individual medication history. They can recommend medications based on the injury type and location. This is an attempt to stop every John Doe back pain sufferer from walking out of his doctor’s office with an RX for Percocet, when he really does not meet the criteria for needing that strong of a medication to begin with. Most strains can resolve by taking a stronger dose of Motrin, an anti-inflammatory medication similar to Advil or Ibuprofen. The PBM will also monitor duration of medication use and quantity limits. Why pay for 90 pills when John Doe should only need 30? Medication costs are associated with dosage as well, so it doesn’t make sense to pay for 90 pills unless they are needed.

 

2.  Start being aggressive at the first prescribed RX.

When a new claim is filed and the adjuster sets the drug card up to be mailed out to the employee, it may already be too late. This is when proper communication is handy. If you have a worse-than-average claim, you can phone your adjuster with the info, and they can get the PBM info right to the claimant.

 

This way they are not getting medication from an occupational clinic or hospital, where the costs are typically the highest. Right off the bat they can use the PBM card, and that reduces cost right from the beginning. This also helps manage future spending on RXs, since they already have the card and should be using it for any medication the claimant is prescribed. Sure, not using the card for your first medication fill is no big deal if you only have one or two claims per year, but if you have one or two claims per week, over the course of a year this can lead to a dramatic savings in medication cost. Every little bit of savings will help in the long run, and it is important not to overlook the small savings that you can implement right away.

 

3. Can you do bulk home delivery?

For those injuries lasting longer than a month, it is worth it to look into home delivery of medications. This increases the discount, because you buy more of the medication at one time, and you do not have to pay the pharmacy overhead for a short-term 30 day fill. Injured workers will appreciate having one less errand to run, especially those who do not have easy transportation readily at hand. At the same point, the PBM will monitor dosage and quantity. Why should you continue to get a medication if it is not helping? Or, if the injured worker is not taking the medication at all? These are leakage costs, and expensive ones at that. The adjuster will ultimately decide if a claim is worthy of needing home delivery, and the delivery will not last forever. If a person has a bad fracture and will need a long-term supply of Motrin, this is a perfect scenario.

 

Adjusters do frown on home delivery of narcotic pain meds. This gives the claimant a large supply of potentially strong medication, which carries the risk of addiction. Home delivery meds are generally milder. Again, even though these drugs may not cost the most, any sort of savings is better than no savings at all.

 

4. Are you using prescription utilization review?

PBM companies use a panel of clinical pharmacists to examine prescription data and injury type to make sure appropriate medication is dispensed. This helps control unnecessary costs due to prescribing incorrect medication. Also, PBM utilization review will help to control fraud by monitoring the date and location of refills. Red flags indicating abuse include early refills, a doctor shopping around to get new prescriptions, or a patient changing pharmacies to get refills. Clinical pharmacists also are useful at catching new medication trends, proper quantities of medications, and future costs/needs for ongoing medications. 
 
By using prospective utilization review, done before the product is used, to avoid the cost, consider prior authorization program. By having an MD on the TPA's staff review the file, many of the medication concerns are addressed proactively. The utilization review company you use, should be URAC certified to ensure quality, credentials and training. A good TPA might even have a chronic pain program to discuss pain issues with an interdisciplinary team of experts. 
 
 
 
 
5. Use a Pharmacy Benefit Manager or vendor to help with repeat offenders and duplicate prescription medications.
 
This use of an outside PBM is effective for many reasons, including catching a doctor prescribing both a short-term and long-term narcotic pain medication, duplicate or similar prescriptions being unnecessarily prescribed, and implementing the use of generics whenever possible. The PBM will also participate in state-wide reporting, which will catch if a claimant has other narcotic pain medication fills before the date of injury. This can show the worker may have a history of requesting certain narcotics — a red flag for abuse.
 
 
Surveillance companies usually have a service that can do a background check of pharmacies, to see if your claimant has had fills of certain medications aside from the meds needed for your specific injury. This fights fraud, and can expose someone that may have a prescription drug problem. An easy way to get strong medication is to file a comp claim, and any weapons you have to fight fraudulent claims are worth it.(WCxKit)
 
 
In summary, a third-party PBM is a useful tool not only for cost-savings but also for catching the many forms of prescription abuse out there. Doctors get lazy when it comes to prescribing medications. Sometimes the answer to every injury is a prescription of Vicodin, Percocet, or some other narcotic when none are needed. Not only are these medications expensive, but they can carry long-term health problems including addiction, which only increase the overall cost of the claim. Using a PBM is another way of being proactive when it comes to handling your claims, and your carrier/TPA will have more information on what you can do to implement a PBM program for use on all of your claims that require prescription medication.
 

Ask your TPA what programs they offer.
 


Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
 
 

Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

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