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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Industry Leaders Discuss Challenges at Broadspires First Pharmacy Summit

 

pictu1Medications and drugs continue to play an increasingly important role in the overall of medical costs in workers compensation claims. In addition to the increases in costs, the potential claim risks have also increased surrounding the growing use of narcotics in the treatment of pain. These issues impact all involved parties in the claim administration process – from injured worker, to employer, to carrier or payer. How to manage these issues has now become a critical issue.

 

 

 

 

On March 22, 2012, Broadspire, a Crawford Company and leading third party administrator (TPA) and medical management services provider, brought together representatives from a number of key industry organizations to discuss the challenges in prescription drug management for workers compensation claims during its first pharmacy summit.

 

 

 

pictu2

The intention of the summit was to focus on global industry issues, trends and developments in the future. In bringing together resources from all aspects of the pharmacy management process, the group was able to have an all encompassing discussion of the issue, and examine the challenges from all perspectives and vantage points. Throughout the day, the group discussed the common threads that tie together claimant, payer, employer and carrier interests. The group also shared ideas that could be put into practice to improve outcomes for everyone concerned.

 

 

 

 

More than 50 brokers, practice leaders, clinicians and others from major insurers, insurance brokerage firms and pharmacy benefit management (PBM) organizations attended the summit, which was held at Broadspire’s Sunrise, Fla., medical management headquarters. The panels were divided into four key areas of focus

 

  1. Pharmacy program design
  2. Opioids and controlled substances
  3. Physician dispensing
  4. Key legislative updates.

 

 

 

pictu3The first session focused on the overall design of an effective pharmacy program. Panelists in the discussion included Eileen Ramallo, Executive Vice President of Healthcare Solutions; Lori Daugherty, President of PMSI/Tmesys; Atermis Emslie, President of MyMatrixx; and Kathy Tiemeier, Clinical Program Manager of Express Scripts.

 

 

 

 

 

 

pictu4Candy Raphan, RN, BSN, ARNP, MAOM Candy joined Broadspire in 1989.  For over 20 years, she has held various management roles within the Broadspire organization in a variety of functional areas, including Occupational and Non-occupational Disability Management, Utilization Management, Medical Bill Review, Quality, and Medical Management Strategic Outcomes.  In her current role as Director of Medical Services, Candy is a Practice Leader for Broadspire’s Comprehensive Pain Management Solution and responsible for the clinical components of the pharmacy program, medical analytics, reporting and other clinical program development.

 

 


In addition to her experience at Broadspire,
 Candy brings a varied background of clinical, managed care and health industry related experience.  She is a certified advanced registered nurse practitioner with a specialty in family practice, Candy holds a bachelor’s degree and advanced practice certificates in nursing from the University of Miami and a master’s degree in organizational management from the University of Phoenix.  Candy is also a member of the National Association of Professional Women and the American College of Healthcare Executives.

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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.

 

Pill Mills are a Cost Driver in Workers Compensation Claims

The fastest growing area of workers compensation fraud is narcotics abuse. The fake workers comp claim for the purpose of feeding a drug addiction, or for the purpose of obtaining narcotics for resale, is a fast growing problem.  Employers and claim adjusters should proceed with caution when an employee has been given a narcotic prescription, especially when there has not been a recent surgery.

 
The term “pill mills” has been used by law enforcement to describe medical facilities where the primary purpose of the medical facility is to write prescriptions for painkillers.  The U.S. Drug Enforcement Administration (DEA) has been raiding medical facilities in Florida, Georgia, Ohio and other states with mixed results. They close down one pill mill only to have another one pop up. (WCxKit)
 
 
Pill mills often try to camouflage the activity as pain management clinics. There is however some red flags that distinguish a pill mill operation from a legitimate pain management clinic.  Included below are some characteristics of pill mills.
 
-The physician(s) have little training / background in pain management.
-The facility sees a high volume of patients daily.
-The facility provides scant patient examinations before prescribing narcotics.
-The facility both writes the prescription and fills the prescription.
-The facility writes prescriptions for amounts that exceed the manufacturer’s recommendation for maximum usage.
-The price of the prescription is inflated over what the same dosage would cost at a chain drug store.
-The facility operates on a cash-only basis.
-The patients often travel long distances to the facility, even from out of state.
-The facility is often located near an interstate highway for convenience of patients traveling long distances.
-The facility advertises its “services” on Craigslist or other similar Internet sites.
 
 
The abuse of narcotics has gotten so bad that, per the Associated Press, drug overdose deaths have surpassed traffic accidents as the top cause of accidental death in Ohio, Colorado, Massachusetts, New York, Oregon and 11 other states.  According to the Center for Disease Control, 20,000 people a year die from prescription drug overdose.
 
 
Pill mills like the Greater Medical Advance Clinic in Wheelersburg, Ohio are at the center of this epidemic.  According to the arrest documents, the clinic owner, George Marshall Adkins, wore a handgun in the clinic while dispensing tens of thousands of painkillers at inflated prices.
 
 
Employers in Florida should be especially cautious of prescription drug abuse on the workers compensation claims.  According to Florida state officials, 85% of all oxycodone pills sold in the United States come from Florida, with the top 50 medical prescribers of such drugs being located in Florida.
 
Carlos Gonzales in South Florida was arrested for his black market business of selling narcotics.  Gonzales was not an ordinary street level drug dealer.  He was a doctor operating a “pain management center” with numerous workers compensation patients. He lived in a multi-million dollar home with a Mercedes, a Bentley and a Lamborghini parked in the driveway.  The DEA estimated he was making from $13,000 to $20,000 a week writing thousands of prescriptions.
 
 
There are steps an employer can take to stop workers comp fraud / drug abuse through pill mills.  Among the ways the employer can fight workers comp fraud / drug abuse include
 
 
-Operate a drug free workplace – if the employees knows that drug testing for hiring and random drug testing is performed, the employees inclined to abuse drugs (and to file bogus workers comp claims to obtain drugs) will go somewhere else to work until they pull the workers comp fraud.
 
-Drug screen after each injury – a drug screen on the day of the injury should be a part of the immediate medical treatment.  In many states a failed drug screen can be grounds for the denial of the workers comp claim.  In the states where the workers comp claim cannot be denied due to the failed drug screen, the employer will at least know what the employee’s drugs of choice are.
 
-In the states where the employer is allowed to select the medical provider, be sure to do so.  Check the reputation of the medical provider with local defense counsel to eliminate doctors known for over prescribing medications or known for referring employees to questionable pain management clinics.
 
 
-Whenever pain becomes a significant part of the employee’s complaints following an injury, especially pain without visible trauma, a nurse case manager should be assigned to the claim to prevent narcotics abuse.
 
 
-All prescriptions for the injured employee should be filled through a pharmacy benefit manager (PBM).  Any time the employee is exceeding the manufacturer’s recommended maximum dosage, the PBM can review the requested dosage with the medical provider. (WCxKit)
 
 
By taking the above steps, the employer can significantly reduce the number of bogus workers comp claims for the purpose of obtaining narcotics, either for drug abuse or for resale. 
 
 
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.
 
 
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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.
 
 

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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

NEWS on the Federal Employees Compensation Act and Prescription Drug Abuse

The Federal Employees Compensation Act (FECA) covers 2.7 million federal employees and postal workers and paid out $1.9 billion in wage-loss compensation, impairment and death benefits and $898 million in medical and rehabilitation services and supplies during the 2010 charge back year, which ended June 30, 2010.

 
There have been no major revisions to the law since 1974. Currently there are two bills pending. Both would put in place a few significant changes. “The Federal Workers Compensation Modernization and Improvement Act” (HR 2465), was passed in the House and has been sent to the Senate Committee on Homeland Security and Government Affairs. Another proposal that originated in the Senate, “The 21st Century Postal Service Act of 2011” (S1789) has made it out of committee. Both include significant provisions related to FECA reform.(WCxKit)

THE 21ST CENTURY POSTAL SERVICE ACT OF 2011 (S 1789)

There are several provisions
in the current version of the bill that would have a material impact on the claimants and the manner in which claims are managed. Section 302, Federal Workers Compensation Reforms for Retirement Age Employees, will reduce total available compensation rates and re-define coverage at and beyond retirement age. This particular provision would have a positive effect on cost as well as remove any notion that FECA is a retirement plan.

 
This legislation also includes provisions that are directly related to case management; one in particular supports increased involvement by the employing agency in managing its’ workers compensation claims. This provision requires an independent medical assessment of disability and potential for return to work for beneficiaries after six months of disability and on a regular basis thereafter.


Currently, federal agencies do not have the authority to schedule or direct the scheduling of independent medical evaluations. They can request that the Department of Labor set up an exam, but the final decision on whether and when to refer for an IME (independent medical evaluation) is in the hands of the claims examiner (DOL). In addition to requiring periodic scheduling of independent medical evaluations by the DOL, the current draft of the proposed legislation provides a mechanism for the employing agency to direct the scheduling of an IME, subject to review of the request by the Secretary of Labor.

 
The complementary piece of legislation that has passed the House is THE FEDERAL WORKERS COMPENSATION MODERNIZATION AND IMPROVEMENT ACT (HR 2465), which among other things would streamline the claims process for those workers who sustain a traumatic injury in a designated armed conflict zone, would permit physician assistants and nurse practitioners to certify disability for traumatic injuries and ensure that they are reimbursed for their services, and would allow the Department of Labor to verify federal employees salaries against social security administration data, all of which will modernize and streamline administration of FECA benefits.(WCxKit)

PRESCRIPTION OPIOID ABUSE

One significant industry-wide
issue that is not explicit to either piece of proposed legislation is prescription opioid abuse. Prescription opioid abuse is being addressed in most workers compensation systems by establishing controls on prescribing with the help of Pharmacy Benefit Management (PBM) programs. In the federal workers compensation system, only the Department of Labor has the authority to adjudicate claims, including those for ancillary services, which limits the employing agency’s ability to control the inappropriate use of pharmaceuticals.


Although federal agencies can, and a few do, hire PBMs to help address the efficacy and cost of prescription drugs, neither the agency nor the PBM have the authority to place any limits on prescribers or fulfillment beyond those established by OWCP, which are extremely limited. It is hard to imagine how the federal workers compensation system, which provides workers compensation coverage for almost 3 million workers, is going to be able to handle the opioid epidemic without a significant change in policy related to the use of formularies and other preventive controls applied at both the benefit level and the point-of-sale.

Authors Lisa M. Firestone, MHSA and Marianne Cloeren, MD, MPH, FACOEM provide services at Managed Care Advisors, Inc. (MCA) an innovative, woman-owned business specializing in workers' compensation, employee health benefits, disability management consulting, and full service workers compensation case management. Based in Bethesda, Maryland, MCA services customers throughout the United States and U.S. Territories. Visit the MCA’s website www.MCACares.com.
 
Lisa M. Firestone, MHSA is the company’s president and owner and brings her 30 years plus experience to the healthcare industry. She is a recognized expert in the areas of employee benefit program development, evaluation, and strategic planning. She has been actively involved in the evolution of workers’ compensation case management and disability management programs, most recently focusing on the federal workers’ compensation and disability systems. She can be reached at lfirestone@managedcareadvisors.com.
 
Marianne Cloeren, MD, MPH, FACOEM Medical Director of MCA where she supports the company’s federal workers’ compensation case management services, oversees quality assurance, and develops educational offerings related to disability management and evaluation. Dr. Cloeren’s experience includes managing employee health in the Veterans Administration system, serving as medical director for several companies, and as an occupational medicine physician for the Army’s Center for Health Promotion and Preventive Medicine, where her focus was federal workers’ compensation case management. She can be reached at mcloeren@managedcareadvisors.com.


 
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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.

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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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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