… on a proactive approach to managing narcotics
Did you know that 84% of narcotic spend can be attributed to only 20% of injured workers?
While pain management is an important element in a physician’s treatment of an injured worker, the line between helpful and harmful can be very thin when it comes to narcotics. The best way to curb abuse of narcotics is to prevent misuse before it happens.
But given the cost and safety concerns, why isn’t there being more done to proactively manage narcotics?
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One of the ways we’re addressing this issue is through our Narcotic Morphine Equivalent Dose (MED) Management Program. This proactive program is uniquely designed to work hand-in-hand with retrospective solutions to manage narcotic utilization completely and appropriately.
We understand that managing narcotic use and spend is a big concern for payers. The Narcotic MED program is just one example of how our goals are aligned – provide safe and effective treatment, while minimizing costs.
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Proactive Approach to Manage Narcotics
Express Scripts Morphine Equivalent Dose (MED) management program helps ensure appropriate utilization to increase patient safety in worker’s compensation
Ensuring safe and appropriate use of narcotics is a fundamental need for workers’ compensation payers. These drugs have a high potential for abuse and addiction, and overdoses from narcotics cause more deaths each year than cocaine and heroin combined.
As part of a new workers’ compensation offering announced today, the Express Scripts Morphine Equivalent Dose (MED) program is a proactive approach to managing narcotic utilization.
Ensuring Safety of Morphine Equivalent Dose
MED is the calculation used to determine a narcotic medication’s morphine-like potency in conjunction with its dosage. Calculating the MED provides insight into the total dosage of narcotics that an injured worker is being prescribed as part of his treatment regimen.
According to the Washington State Agency Medical Director’s Group (AMDG), patients receiving 100mg or more per day of MED had a ninefold increase in overdose risk.
How Does It Work?
Express Scripts’ MED program is a real-time, proactive approach to managing narcotic utilization in workers’ compensation. When a prescription is presented at the pharmacy, Express Scripts’ proprietary claims processing system calculates the MED value for the individual prescription and the cumulative level for all the medications the injured worker has been prescribed. If the prescription does not exceed the client-specified MED threshold, the prescription is filled. If either the individual or cumulative MED values are too high, the prescription is submitted to the payer to review for appropriateness.
New Solution for Narcotic Management
By accounting for individual prescriptions as well as cumulative levels, the MED program enables payers to have a broader management of narcotic utilization, while ensuring injured workers maintain access to needed medications.
Most importantly, this keeps injured workers safe. As stated in the AMDG guidelines, “Effective use of opioids must result in clinically meaningful improvement in function, and a decrease in pain intensity in the absence of improved function is not considered clinically meaningful.” The AMDG guidelines also recommend that injured workers seek pain management consultation when MED is more than 120mg a day.
When payers can aggressively and proactively manage narcotic utilization, they minimize risks for misuse and improve health outcomes for injured workers.
Visit Express-Scripts.com/WorkersCompensation for more information on industry-leading solutions to help control the cost of your workers’ compensation pharmacy spend.
Author Jennifer Kaburick, RN, MBA, is Senior Vice President, Workers’ Compensation Product Management & Strategic Initiatives, at Express Scripts. Jennifer provides strategic direction and oversight to the Product Management team, who develop programs and services designed to give clients maximum value and ease of use for injured workers. She is responsible for identifying product opportunities that address key industry issues while helping to enhance overall client and injured worker outcomes. As a nurse and a former adjuster, Jennifer’s experience provides her with a unique perspective from all sides of the workers’ compensation pharmacy program.
