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

 


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©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.

 

Solutions to the American Prescription Drug Abuse Epidemic Part III

 
Stuart Colburn, Esq., has done it again with his third installation on prescription drug abuse in America for the LexisNexis Communities on Workers Compensation. Part One explained “the problem”. Part Two identified stakeholders and his final blog offers solutions. You may read his complete blog here or take a look at this brief summary.
 
1. Government Regulation
“Prescription drug abuse and diversion is a problem requiring close interaction between public and private sectors. Stakeholders must work together using tools at their disposal in a coordinated effort to fight supply and demand,” Colburn wrote. He suggests a prescription drug monitoring program (PDMP) that would include:
 
– Scheduled and other highly abusive substances.
– Real time data transmission between stakeholders.
 -A requirement for doctors to check the PDMP database before writing a prescription.
– A requirement for pharmacies to check the PDMP database before dispensing narcotics.
Integration with neighboring states.
 
 
2. Physicians
“The public has an unreasonable view of the knowledge base of healthcare providers. Although every doctor graduated from medical school, knowledge itself comes from specialized training,” he wrote, “Scheduled narcotics should only be prescribed by doctors with the requisite training and experience. Those doctors granted the additional license to prescribe scheduled narcotics would be subject to additional regulation.”
 
 
3. Pharmacies
“Pharmacies should be required to participate in a prescription drug monitoring program for scheduled narcotics before dispensing scheduled narcotics,” Colburn suggested.
 
 
4. Pharmaceutical Companies
Drug companies should design drugs to deter abuse. Drug companies can employ manufacturing techniques, making it more difficult or impossible for drugs to be ground up into a powder,” he added.
 
 
5. Consumers
“Public education about prescription drug abuse should be paramount on billboards and in our school systems. Every day, 7,000 young people abuse prescription narcotics for the first time. Patients who receive a prescription or scheduled narcotics should also undergo approved education and information,” Colburn wrote.
 
 
6. Payers
“Payers should implement strategies designed to identify addicts, diverts and outliers. Payers should urge policy makers to adopt PDMP and common sense laws giving regulators the information and power necessary to fight PDA,” he wrote. “Payers have ever more increasingly sophisticated software able to perform advanced predictive modeling and performance analytics that can identify outlier doctors and possible addicts.”
 
 
© Copyright 2011 Stuart Colburn, Esq. Reprinted with permission.
For more information about LexisNexis products and solutions connect with them and become part of the conversation at Workers Compensation Law Community

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

 
 
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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 Info@ReduceYourWorkersComp.com

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