Ohio Pharmacy Management Initiatives Save 2.6 Million in Prescription Costs

Pharmacy Management Initiatives Positive for Injured Workers

A recent report to the Ohio Bureau of Workers Compensation (BWC) Board of Directors outlined how the bureau’s first ever formulary and a number of other pharmacy management initiatives are helping in efforts to increase positive outcomes for injured workers.

Narcotics Prescribed Down 1.1 million doses

The report includes early data showing a newly enacted formulary has driven down the number of narcotics prescribed to injured workers by 12 percent, or 1.1 million doses, supporting Governor John Kasich’s efforts to address the Ohio’s opiate epidemic.

“Ohio’s new formulary is proving an effective way to help manage care and ensure we are getting injured workers the right prescriptions for the right conditions at the right time,” said BWC Administrator/CEO Steve Buehrer. “While narcotics can be a legitimate part of the treatment process, we owe it to Ohio’s workers to ensure their road to recovery doesn’t descend down the dark path of addiction.” [WCx]

$2.6 million Saved in Prescription Costs

A review of prescriptions written from February to April 2012, compared to the same period in 2011 showed 1.1 million fewer prescribed doses of narcotics. This equals a 12-percent reduction in the number of doses and a 15-percent, or $2.1 million, reduction in costs. The same review showed the number of skeletal muscle relaxants (SMR) prescriptions dropped by 59 percent, resulting in a 58 percent, or $532,000, decrease in cost. SMRs are among the most commonly overused drug classes and are often prescribed in conjunction with narcotics.

BWC began implementing its first ever formulary in September, however, BWC chose to start its study on Feb. 1, the first day that new restrictions on opiates were implemented.

The formulary is helping improve the efficiency and effectiveness of treatment, limit the inappropriate use of medications and lower prescription costs. The formulary provides a concise list of medications that can be utilized for treatment of approved conditions related to an injured worker’s claim and may include guidelines related to their use.

Additional Controls on Pharmacy Program

In addition to the formulary, the presentation by BWC Pharmacy Director John Hanna to the Medical Services & Safety Committee late yesterday covered several other controls BWC is placing on its pharmacy program, including:

Point of service edits that allow BWC’s pharmacy benefits manager, SXC Solutions, to screen out prescriptions that aren’t related to an injured worker’s condition to ensure they are receiving medications relevant to their injury;
The standardization of drug utilization reviews, a process that allows for a timely, objective evaluation of prescriptions an injured worker receives to ensure they are appropriate. Drug utilization reviews evaluate the necessity and appropriateness of prescription drug treatment and can identify overuse or dangers mixing of prescriptions;
A pharmacy lock-in program that was established to limit the practice of doctor and pharmacy shopping, and the dangers that can arise when medications are prescribed by multiple physicians and are processed in different pharmacies. The program allows BWC, under certain circumstances, to require an injured worker to use a single pharmacy for non-emergent prescriptions. BWC can also restrict an injured worker convicted of a drug offense to the use of a single prescribing physician in order to receive reimbursement for non-emergent prescriptions;
Requiring generic medications when available.

“By better understanding and managing the role of pharmaceuticals in recovery, we are helping injured workers heal and get back on the job sooner,” said Buehrer. “The added benefit is the cost savings that help us keep premiums affordable for Ohio’s businesses.” [WCx]

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

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.