“There is no such thing as an FDA-approved compound medication.” That statement from myMatrixx Chief Clinical Officer Phil Walls underscores one of the main criticisms of these medications; while the drugs within the mixtures may all be FDA-approved, the specific combinations have not been tested and verified.

Safety is just one concern, however. The other is cost; they generally are priced significantly higher than similar, FDA-approved drugs or the sum of their underlying medications.

Both the utilization and the average cost of compounded medications in the workers’ compensation system has decreased in recent years. However, there are still pockets of excessive use. Stakeholders need to maintain a steady and continued focus on efforts to curb the unnecessary use of these pharmaceuticals.

Problems Cited

Compounds are a mixture of drugs intended for a specific patient’s use. According to an FDA report, they are beneficial only in limited circumstances; such as when other medications have failed, a patient is allergic to some of the inactive ingredients or has difficulty swallowing.

The federal agency inspected compounding facilities and noted the following “troubling conditions” that could lead to widespread harm of patients:

1. Toaster ovens used for sterilization.
2. Pet beds near sterile compounding areas.
3. Operators are handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others.

Latest Stats

Compounded medications are not considered first-line therapy for pain or other common conditions of injured workers according to industry guidelines, such as evidence-based medicine guidelines from Work Loss Data Institute, American College of Occupational and Environmental Medicine, and many other state-specific guidelines.

Compounds are available in many applications but are used in workers’ compensation most often as topical products for pain management. Usually, compounded medications are excluded from workers’ compensation formularies, and require prior authorization before they are dispensed to an injured worker.

State legislatures and organizations within the workers’ compensation system have taken steps in recent years to reduce the overuse of compounds, and they have been largely effective, according to the most recent Drug Trend Report in the workers’ compensation system from myMatrixx:

• Spending on compounded medications declined 37.1 percent in 2017
• It was the third year in a row that payer spending on compounded drugs has decreased
• Compounds fell from the top 10 therapy classes
• Utilization decreased 21.2 percent
• The average cost of compounded medications decreased 15.9 percent

Along with the good news, however, are some disturbing reports.

Recent Problems

• Pennsylvania. A recent report found that legislative reforms in the state resulted in cost savings on physician-dispensed drugs; however, they were offset by an increase in pharmacy dispensing of expensive compound drugs.

The legislation that took effect in December 2014 capped prices paid for physician-dispensed drugs and restricted physician’s ability to dispense opioids and other drugs to limited timeframes. The Workers Compensation Research Institute found there was an associated decrease in the number of injured workers who received physician-dispensed drugs. But they also found there was a “dramatic” increase in the prescription payments for compound drugs in the same years, which it attributed to the emergence of new pharmacies dispensing expensive drug products, especially compound drug prescriptions.

• Texas. A loophole in the state’s drug formulary allowed compound prescriptions to be filled without obtaining preauthorization to confirm medical necessity. Regulators said the workers’ compensation system saw a 46.4 percent increase in compound prescriptions from 2010 to 2014, with the total cost of an average prescription more than doubling from $356 to $829.

Solutions

A new rule amended the Texas formulary to exclude any prescription drug created through compounding and required preauthorization for all compounded medications. That rule took effect July 1. Several additional states have adopted similar measures, including Arkansas, Oklahoma, Florida, Nevada and Tennessee, and the idea is being considered in other jurisdictions.

The National Conference of Insurance Legislators is considering model legislation with clearly established guidelines for the reimbursement of pharmaceutical products in the workers’ compensation system. It includes language that would limit compound medications and require a critical evaluation with a physician documented statement of medical necessity or a utilization review of the compounded pharmaceutical products.

Stakeholders can work closely with state regulators and legislators. Additional ways to address the issue of excessive use of compound medications include:

1. Working closely with a pharmacy benefit manager to ensure compounds are used judiciously and only when preauthorized
2. Payment limits. Placing reimbursement limits per each script or per each ingredient in a compound medication
3. Limiting the number of ingredients or the total cost per script
4. Retrospective review. Allowing employers the option to deny coverage for a compound medication that has not been preauthorized
5. Network pharmacies. Allowing employers to direct injured workers to specific pharmacies
6. Including compound medications in the list of medications allowed only with preauthorization

Conclusion

The overuse of compound medications has been a troubling area for workers’ compensation stakeholders for several years. Strategies to address the issue are effective but must be continually employed and updated to ensure the problem is appropriately managed.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The latest trend in medications for injured workers is good news indeed — for the most part. But one tiny area can add up to major dollars. Spending on specialty medications increased 3.8 percent in 2017, according to the latest Drug Trend Report from myMatrixx, an Express Scripts company.

The fact that these drugs represent less than 1 percent of all medications used by injured workers is by no means a reason to overlook them. Because of the high costs associated with specialty medications, payers need to stay vigilant in understanding and addressing this small but growing segment of pharmacy spend.

The Issue

HIV, osteoarthritis, high cholesterol, and hepatitis C are among the comorbidities that require prescriptions for specialty medications. Just over 2 percent of injured workers used one of these drugs last year, accounting for 0.6 percent of all prescriptions filled and 6.3 percent of total pharmacy spend.

The most used specialty drug for injured workers in 2017 based on per-user-per-year spend according to myMatrixx, was Truvada®, used to treat pre-exposure to HIV. The cost per Rx was $1,019.11. The overall use of medications to treat HIV increased by 17.6 percent — not too surprising considering the need for them to treat workers with occupational exposure to needle sticks.

However, the use of medications to treat osteoarthritis rose 21.6 percent, while the cost per prescription increased 1.1 percent. The medication Synvisc had increased utilization of more than 58 percent. Driving the increase was likely the fact that workers may use the drug for repetitive stress injuries caused by activities that stress the knee joint — squatting, kneeling or lifting heavy objects.

The most expensive medication on the top 10 list is Epclusa®, with a price tag per Rx of $24,510. However, the drug has been hailed as curing the disease.

Affected Workers

Workers in a variety of occupations may need specialty drugs.

• Medical workers may contract HIV and hepatitis C from blood-borne pathogens due to exposures to needlesticks.
• Coal miners are at risk of black lung disease
• Outdoor workers are vulnerable to Lyme disease.

Other reasons workers may need specialty drugs include postoperative blood clots and organ failure.

The Drugs

The top 10 specialty medications for 2017 according to myMatrixx were:

Drug                           Therapy Class

Truvada®                    HIV

Isentress®                   HIV

Synvisc-One®            Osteoarthritis

Xolair®                       Asthma

Enbrel SureClick®     Inflammatory conditions

Enoxaparin                  Anticoagulant

Repatha SureClick®   High cholesterol

Enbrel ®                     Inflammatory conditions

Xyrem®                      Anti-cataplectic agents

Epclusa®                    Hepatitis C

What to Do

It’s important for claims handlers and injured workers to have a clear understanding of how and why they are using these medications. They often require special handling instructions, for example. While denying a specialty medication to an injured worker in need would not be prudent, organizations can rein in costs and prevent overutilization by ensuring the drugs are used appropriately and judiciously.

1. Train. Injured workers and those involved with the claim should know what side effects may be present with each specialty medication. Injured workers should be well informed about self-administering the medications.

2. Monitor. These injured workers often need ongoing clinical monitoring and more intensive help from pharmacists and other caregivers to ensure they are taking the medications as prescribed, as patient adherence is crucial.

3. Use specialists. Specialty pharmacies are better equipped and should be utilized for handling these medications, as they typically offer services not available at retail pharmacies. For example, on-staff nurses and physicians who are experts in the conditions and treatment are likely to be available only in specialty pharmacies.

4. Engage physicians. Nurse case managers and other caregivers should work with treating physicians to make sure the injured worker is getting the proper medications and treatment. Some medications, including Repatha for high cholesterol, are appropriate only for a small number of patients and must be appropriately managed for patient safety and costs. Cancer medications are not usually included in workers’ compensation formularies and therefore may require prior authorization.

Conclusion

Specialty medications represent just a fractional component of prescriptions filled by injured workers, yet their costs can be nearly prohibitive. Since they offer an important lifeline for injured workers who truly need them, it’s important to see they are prescribed only where appropriate and are taken as prescribed.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

There is good news on the opioid front in the workers’ compensation system. According to the latest Workers’ Compensation Drug Trend Report from myMatrixx, an Express Scripts company,

• Average spending on the drugs declined 11.9 percent
• The percentage of injured workers using opioids for at least 30 days decreased by a couple of percentage points
• The morphine-equivalent dose (MED) declined — with a 33.7 percent reduction in cumulative MED greater-than 100 and a 26.9 percent decrease in cumulative MED overall.

But the good news is tempered by the persistent problem of opioids prescribed in conjunction with other medications that together form a dangerous interaction. While the numbers were somewhat better in 2017 than the previous year, there are still too many injured workers being put at risk for overdoses and death. Education and outreach are needed to address the problem.

The Facts

According to the Drug Trend report, 74.2 percent of payers spent less on opioids in 2017 than in 2016. The average amount per claim declined to $342.57, compared to $388.80 in 2016. Opioids continued to be the most expensive and highly used class of drugs among injured workers and accounted for 24.1 percent of total pharmacy spend in 2017.

“While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done,” according to the report. “Nearly 40 percent of injured workers took an opioid along with a muscle relaxant, while 9 percent took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.”

The report showed that in 2017

• 7 percent of injured workers took an opioid and a muscle relaxant, compared to 31.1 percent in 2016.
• 3 percent took an opioid and a benzodiazepine last year, compared to 7.3 percent the previous year.
• 5 percent took an opioid, a muscle relaxant and a benzodiazepine in 2016, compared to 3.1 percent in 2016.
• Among injured workers using opioids for a short-term (less than a 30 days’ supply), 79.6 percent used opioids only, and4 percent used an opioid and a muscle relaxant.
• For injured workers using opioids for more than 30 days, 36.1 percent filled both an opioid and a muscle relaxant.

Despite the slightly better news, there is still much to be done to curb the problem of combining opioids with certain other drugs. The federal government reports more than 30 percent of overdoses involving opioids also involve benzodiazepines or ‘benzos.’ These drugs are used to help anxiety, insomnia, muscle tension, seizures, and alcohol withdrawal. Both benzos and opioids suppress breathing, sedate users and impair cognitive functions.

Benzos are commonly sold under the names Valium, Xanax, and Klonopin. Additionally, some benzos, have muscle relaxant properties and are often prescribed for injured workers with muscle spasms.

The Centers for Disease Control and Prevention issued new guidelines in 2016 that recommend clinicians avoid prescribing benzos concurrently with opioids whenever possible. Both opioids and benzo medications now carry warnings from the Food and Drug Administration (FDA) highlighting the dangers of using the drugs together.

Research clearly shows the dangers of combining opioids with benzos. In a North Carolina study, for example, researchers found the overdose death rate among patients receiving both types of medications was 10 times higher than among those who only received opioids.

Part of the problem is that physicians may prescribe opioids on a long-term basis to treat acute or chronic pain, along with Valium to treat muscle spasms. Injured workers may also receive a Xanax prescription from a therapist if they suffer from anxiety.

Additional Medication Dangers

In addition to muscle relaxants and benzos, many other medications can be harmful when taken in combination with opioids. The FDA has issued warnings for physicians to limit their prescribing of the following for patients on opioids:

• Antidepressants
• Migraine medications
• Antipsychotic drugs
• Sleep medications
• Serotonergic drugs, such as St. John’s wort.

There’s also evidence that antihistamines, which can cause drowsiness and sedation, may be problematic when combined with opioids. Finally, mixing alcohol with opioids can be deadly.

Risks

Over sedation and depressed breathing are two of the biggest problems resulting from a mix of opioids with other medications. Over sedation renders the person unable to wake up or respond to stimuli, creating risks for falling or slipping into a coma. Depressed breathing leads to a lack of oxygen to the brain and eventually shuts down vital organ systems, causing brain damage or death.

There are additional risks as well.

• Serotonin Syndrome, a serious central nervous system reaction occurs when high levels of the chemical serotonin build up in the brain and cause toxicity. Symptoms may include agitation, hallucinations, rapid heart rate, excessive sweating, shivering, muscle twitching and trouble with coordination.

• Adrenal insufficiency is a rare but serious condition in which adequate amounts of the hormone cortisol cannot be produced. Cortisol helps the body respond to stress. Symptoms of adrenal insufficiency include nausea, vomiting, loss of appetite, fatigue, weakness, dizziness or low blood pressure.

• Decreased sex hormone levels are associated with long-term use of opioids and can reduce the person’s interest in sex, or lead to impotence or infertility.

Knowing the symptoms of an overdose is important, and may include

• Pinpoint pupils
• Unconsciousness
• Dizziness or lightheadedness
• Extreme sleepiness
• Slowed, irregular breathing
• Confusion
• Unresponsiveness
• Blue lips
• Snoring or gurgling sound in the throat

Educating patients and physicians about the dangers of combining opioids with many other medications is the first step to reduce the problem. Those managing claims should reach out to prescribers to ensure they understand the risks of interaction.

Conclusion

The combination of opioids with other medications should only be prescribed to patients who do not respond adequately to other treatments. If they do, the dosages and duration of each medication should be the lowest amount possible.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Identifying and intervening with at-risk injured workers can save payers a bundle. These are the so-called “creeping catastrophic’ claims; the seemingly minor injuries expected to resolve within weeks that go south and before you know it, have been on the books for months or longer. They typically involve a variety of expensive medical procedures and medications, all of which are unsuccessful in alleviating the person’s pain.

This small fraction of workers’ compensation claims encompasses a majority of costs for payers. In recent years, the industry has done a better job of red-flagging these claimants earlier in the process. But an oft-overlooked tool to help is urine drug testing.

Urine Drug Testing helps physicians whether the patient is compliant with prescribed medications and/or using non-prescriber or illicit drugs.

But UDT has been ignored in many cases or overused in others. Using UDT judiciously can be a tremendous help.

The Stats

Recent research shows fewer than half the injured workers prescribed opioids received UDT – 17 percent to 50 percent. However, it also showed that of the top 5 percent of claims, UDT was conducted in 7 out of 10 physician visits.

Guidelines from the American College of Occupational and Environmental Medicine, the Official Disability Guidelines and the Washington State Interagency vary regarding UDT frequency recommendation. But they all call for UDT at baseline when opioids are initially prescribed, then at various times throughout the year based on the injured worker’s risk stratification. Those at low risk may only need UDT every six months to annually; while high-risk claimants might need to be tested monthly.

The testing provides objective information to support improved clinical decision making, and helps medical providers:

• Monitor and support their decisions about medications.
• Identify recent use of prescription and illicit substances.
• Detect medications that may negatively interact with other drugs.
• Better communicate with their patients about their treatment plan.
• Identify possible medication abuse and misuse.

A recent national sampling of more than 11,000 testing specimens revealed that fewer than half – 47 percent – adhered to their treatment regimens. That means more than half were not taking their medications as prescribed, taking other medications that were not prescribed, or used illicit substances. It is, therefore, incumbent on organizations to include UDT as part of their treatment plans for injured workers prescribed opioids – especially those at higher risk.

Whom to Test

Testing all injured workers might not be feasible or practical. However, there are certain injured workers who should undergo UDT. Identifying those at risk for delayed recovery can involve several steps. One is risk factors for substance abuse disorders, such as:

• History of substance abuse disorder.
• Family history of substance abuse.
• Major psychiatric disorder.
• Cigarette smoking.
• Preadolescent sexual behavior.
• Poor family support.

Injured workers with no history of substance abuse – their own or their families, and no psychiatric history or other risk factors would be considered at low risk for substance abuse disorders. They should undergo UDT when opioids are initially prescribed, then yearly. It should be noted, however, that a person’s risk level can change. Medical providers should be instructed to watch for aberrant behavior or any signs of a problem.

Injured workers with substance abuse histories of non-opioids, and/or factors such as family history of substance abuse or psychiatric histories would be considered at moderate to high risk and should be tested two to four times per year, as well as when they initially prescribed opioids.

Patients Found Abusing

Those who are currently abusing or addicted to substances and/or have psychiatric histories or other factors present would be considered high-risk patients. These patients should no longer receive opioids from their primary physician and be referred for addiction therapy.    These injured workers should be tested at least three times a year and possibly as much as monthly, according to the guidelines.

Data from pharmacies can also be helpful in identifying injured workers at higher risk. Pharmacy benefit managers can help identify at-risk claimants based on their patterns of medication use, for example.

Once an injured worker has undergone testing, it’s important to have an expert interpret the results and help determine whether and what type of intervention may be necessary. Expert interpretation is generally provided by the testing lab. An employer may also consider consulting with a medical advisor.

Practical Tips for Employers / Payers Implementing UDT

• Avoid poor quality and abuse by not letting doctors complete their own testing.
• Contract for a panel of tests with a reputable lab.
• Direct testing from physicians to the preferred lab.

Conclusion

There are a variety of tools that can help early identification of injured workers at risk of poor outcomes. UDT can be valuable when it is done with the proper frequency, and when the results are accurately understood and acted upon.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

One of the driving factors in workers’ compensation cost containment is pharmaceutical waste.  This waste is having a significant impact on the medical costs associated with claims.  Seeking partners that have solutions to reduce waste can lead to a more effective program and benefit all interested stakeholders.

Waste in Pharmacy Benefits Defined

The concept of “waste” can be defined as the extra amount of money spent with no incremental gain in health outcomes.  In the area of pharmacy benefits, this most often takes place when prescription medications are dispensed through more expensive methods of delivery to the injured worker, for example through the physician’s office directly. It can also be the result of inexperienced healthcare consumers—the injured worker—making misinformed decisions on where to receive their prescription medications.

Trends in Work Comp Pharmacy Benefits Costs

According to Express Script’s Workers’ Compensation Drug Trend Report, payers spend 58% more for physician-dispensed medications than for pharmacy-dispensed medications. Also, medications dispensed via home delivery will often realize a greater discount than pharmacy-dispensed medications.

The 2016 NCCI Workers’ Compensation and Prescription Drugs Research Brief states “recent Rx findings include the countrywide 2014 physician‐dispensed share of prescription drug costs was 10%…in highly regulated states the physician‐dispensed share of prescription drug costs was less than 2%…if not highly regulated…costs exceeded 20%.”

Convenience and Safety

The most attractive feature of physician dispensing for the injured worker is convenience.  However, it is important to recognize that medications dispensed from a physician’s office are not subject to the same safety controls and oversight as in retail or home delivery pharmacy.

Do Not Allow Physician Dispensing

If the employee’s medical provider has been dispensing medication to the injured employee from the provider’s office, send a letter to the employee, employee’s attorney, and the doctor advising that the PBM should provide all medications through the pharmacy benefit card provided to the employee. The letter to the employee should detail the safety concerns, as well as highlight the benefits and potential to eliminate waste. In addition, encourage PPOs to create policy forbidding network physicians to dispense drugs.

Reasons to avoid physician dispensing:

• Cost of drugs is significantly higher
• Dispensing from physicians office bypasses all of the safety measures of prospective and retrospective review by the PBM.
• Misaligned financial incentives for prescribing physician

Consider Home Delivery For Long-Term Medications

Home delivery is the most convenient, safe, and cost-effective delivery channel when an injured worker is taking long-term medications for their injuries. The use of home delivery a successful model that can meet the needs of all interested stakeholders in a workers’ compensation program.

• Insurance Carriers and TPAs: Home delivery meets the needs of this stakeholder by reducing costs associated with pharmacy claims and reducing waste.  It allows for the easy monitoring of what prescription medications are being ordered to avoid issues associated with addiction.  It can also reduce dispensing costs and streamlines billing purposes.  This is especially the case of self-insured employers or those who use TPAs to administer their workers’ compensation programs; and

• Injured workers: Home delivery is the most convenient mechanism for an injured worker to receive their long-term prescription medication.  It is predictable, reduces waste, and utilizes state-of-the-art technology, checkpoints, and automation to virtually eliminate errors that error retail pharmacy.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

“We find extensive opioid prescribing leads to longer duration of temporary disability. When we compare the effect of longer-term opioid prescriptions with no opioid prescriptions, the effect is to triple the duration of temporary disability benefits.”

That finding from the Workers Compensation Research Institute highlights the latest trends in the opioid epidemic as it relates to the workers’ compensation industry. It represents the first evidence of a causal relationship between long-term opioid use and disability duration. The authors will be on hand to delve into the research and the topic during WCRI’s Annual Issues and Research Conference in Boston this month.

Latest Evidence

The WCRI researchers looked at data from 28 states for low back pain injuries between 2008 and 2013 where workers had more than 7 days of lost work time. Additional findings were:

1. Local prescribing patterns play a significant role in whether injured workers receive opioid prescriptions. In certain states and particular areas within states, injured workers are more likely to receive opioid prescriptions than in other areas. When they compared injured workers with the same injuries in different areas, they found that a 10 percentage point increase in the local rate of longer-term opioid prescribing was associated with a 2.6 percentage point higher likelihood that a similarly injured worker would receive longer-term opioid prescriptions.

2. Opioid prescriptions persist, despite recommendations against them. While most medical guidelines do not typically recommend prescribing of long-term opioids for low back pain, about 12 percent of WCRI’s sample had them prescribed, and about 39 percent of workers had at least three opioid prescriptions.

Experts Weigh In

In addition to reviewing the most up to date trends, conference attendees will also hear about successful solutions employers are undertaking. The session “Saving Lives—Building a Modern Pharmacy Program amid a Deadly Epidemic” will feature the medical director of the Ohio Bureau of Workers’ Compensation discussing interventions that have had notable results:

• 2011 — more than 8,000 injured workers in Ohio were opioid dependent; meaning they were taking the equivalent of at least 60 mg a day of morphine for at least 60 days.
• 2017 — by the end of the year, the number was reduced to 3,315.

Dr. Terrence Welsh will outline the steps the Bureau took to reduce by 4,714 the number of injured workers at risk for opioid addiction.

United Airlines has undertaken various initiatives to curb the misuse of opioids among its injured workers, which will be outlined in a separate session. Joan Vincenz joins a representative from the National Safety Council and another from WCRI to discuss how opioids are impacting the workplace and steps employers can take to mitigate them.

A growing interest in medical marijuana and its potential effect on opioid prescribing for chronic pain patients is the focus of a discussion in another session. Dr. David Bradford of the University of Georgia will share results of a new study on drugs used to treat clinical conditions for which marijuana might be a potential alternative treatment.

The Evolution of WC

In addition to the opioid epidemic, the conference also focuses on how the work world is changing and the potential impact on workers’ compensation.

• Will robots take our jobs?
• Will the workplace be safer with automation or less safe with undertrained independent contractors?
• How will we insure the new workplace?
• Will new legal cases arise around independent contractors and on-the-job injuries?

Those are among the questions a distinguished panel of workers’ compensation thought leaders will attempt to answer. A representative each from a large employer, carrier, judicial sector, and labor will make their predictions.

A longer-term forecast is expected in the session, “Scenarios: Workers’ Compensation 2030.” Former WCRI President and CEO Richard Victor will examine external forces shaping the world and the challenges they pose to the industry.

The conference, with the theme “Work and the Comp System: Evolution, Disruption, and the Future,” takes place March 22 and 23 in Boston.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

More than 70 percent of employers say they have felt the impact of prescription drug usage. That sobering statistic from the National Safety Council highlights the fact that, despite successful efforts by some employers and Pharmacy Benefit Managers to stem the abuse and misuse of opioids and other legal drugs among injured workers, the workplace continues reeling from the effects of legal medications.

The NSC’s survey of employers shows there are many areas where employers can take action to address the issue, and for each employee helped, employers can save more than $3,200 annually. Representatives of the NSC, United Airlines, and the Workers Compensation Research Institute will unveil the latest research on how opioids are impacting employers, and the duration of disability for injured workers, during WCRI’s upcoming annual conference.

Substance Use Disorder

‘Substance use disorder’ is the current term to describe the recurrent use of alcohol and drugs that cause clinically and functionally significant impairment, including health problems, disability and a failure to meet major responsibilities at work, school or home. The terms substance abuse and substance dependence are no longer used, according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders.

In 2014, there were an estimated 1.9 million people with opioid use disorder related to prescription pain relievers and an estimated 586,000 with an opioid use disorder related to heroin use. There are a variety of symptoms, such as an inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.

Impact on Employers

Absenteeism is cited as the #1 impact of prescription drugs in the workplace, according to the NSC survey. Workers who have substance use disorders miss almost 50 percent more work days than their peers — up to six weeks annually.

Using pain relievers at work, having a positive drug test and being impaired or having decreased job performance were also included on the list of ways prescription drugs have impacted companies.

‘Near miss or injury’ was named by 15 percent of the respondents as a problem among prescription drug abusers. 84 percent of the employers cited concern over the costs of workers’ compensation because of prescription drug use.

Here are some additional findings from the survey:

• 76 percent are not offering training on how to identify signs of misuse.
• 81 percent lack a comprehensive drug-free workplace policy. Of those that do a drug test, 41 percent don’t test for synthetic opioids.
• 19 percent feel ‘extremely prepared’ to deal with prescription drug misuse.
• 70 percent would like to help employees return to work following appropriate treatment.
• 88 percent are interested in insurance coverage for alternative pain treatments

The NSC conducted the survey of more than 500 HR decision makers for companies with at least 50 employees. Looking at specific industries and demographics, the Council said construction, entertainment, recreation and food service sectors have twice the national average of employees with substance use disorders.

Industries dominated by women or older adults had a two-thirds lower rate of substance abuse, and industries that have higher numbers of workers with alcohol use disorders also had more illicit drug, pain medication and marijuana use disorders

Employers were most concerned about the costs of benefits associated with substance use disorders, and their ability to hire qualified workers. They were less concerned about drug misuse and illegal drug sales or use.

The NSC also said that workers who are in recovery have lower turnover rates and are less likely to miss workdays, less likely to be hospitalized and have fewer doctor visits.

While 71 percent of employers say prescription drug misuse is a disease that requires treatment, 65 also feel it is a justifiable reason to fire an employee.

Action Steps

Healthcare costs for employees who misuse or abuse prescription drugs are three times higher than for other employees. And the annual cost of untreated substance use disorder ranges from $2,600 to as high as more than $13,000 per employee.

The good news is employers can take steps to protect their companies and employees. They include:

1. Recognize prescription drugs impact the bottom line
2. Enact strong company drug policies
3. Expand drug panel testing to include opioids
4. Train supervisors and employees to spot the first signs of drug misuse
5. Treat substance abuse as a disease
6. Leverage a best-in-class Pharmacy Benefits Management provider relationship

Conclusion

Nearly 21 million are living with substance use disorders of one type or another; more than the entire population of the state of New York. Most of those people are employed.
The problem costs the U.S. economy more than $400 billion per year. Employers can play a significant role in reducing this epidemic. In fact, employer-supported and monitored treatment yields better-sustained recovery rates than treatment initiated at the request of friends and family members.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

They say the best consumer is an informed consumer. This statement is certainly true for injured workers being prescribed opioids.

Among the steps that will help curb the opioid epidemic in this country is educating patients. Most people are not fully aware of the effects of these drugs or that they are not the only option for treating pain.

“I’ve always felt that if patients knew all the risks, beyond those of addiction, many of them would opt for one of the other therapies,” said Phil Walls, Chief Clinical Officer of myMatrixx. In his webinar series on patient advocacy and opioid therapy, Walls stresses the idea of arming injured workers with full knowledge of the side effects and warnings before starting them on opioids. He suggests providers use information available on the internet from the federal government to begin a dialogue with injured workers.

Many Risks of Opioids

While the risks of addiction, overdose, and death have been well publicized with prolonged use of opioids, there is also the danger of tolerance. Tolerance means the person will need to take more of the medicine to get the same pain relief; and a higher risk of physical dependence, along with withdrawal symptoms is present if the drugs are stopped.

There are many other, less publicized risks from opioids. The Centers for Disease Control and Prevention outlines several of them in its Prescription Opioid Factsheet for Providers:

• Increased sensitivity to pain
• Constipation
• Nausea, vomiting, and dry mouth
• Sleepiness and dizziness
• Confusion
• Depression
• Low levels of testosterone that can result in lower sex drive, energy, and strength
• Itching and sweating

The risks are even higher when certain other conditions are present. Sleep apnea, for example, heightens the risk of side effects, as does pregnancy, depression, and being 65 years of age or older.

Mixing opioids with other medications can be dangerous or even fatal. A cocktail of benzodiazepines — Xanax or valium — and muscle relaxants should be avoided “unless specifically advised by your health care provider,” according to the CDC.

Alternatives

“Opioids are not the first line or routine therapy for chronic pain,” the CDC explains. Research shows that other medications with far fewer side effects can be as, or more effective for pain relief if taken as prescribed. These alternatives include acetaminophen, ibuprofen, and naproxen.

Other non-medicinal treatments for chronic pain include physical therapy, and cognitive behavioral therapy (CBT). CBT is a short-term, goal-directed approach that teaches patients how to modify their thinking and behaviors to manage pain.

For injured workers who fail to get pain relief from any other measures and are prescribed opioids, nonpharmacologic therapy, and nonopioid pharmacologic therapy should be combined with them, the CDC advises. Opioid therapy should be considered “only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Discussion Starters

In addition to the CDC, other government entities also have valuable information available on the web. One is the Food and Drug Administration.

“How does the FDA approach patient advocacy with regard to opioids? They arm the patient with questions to ask their provider,” Walls explains. “This is a very interesting approach because the FDA is empowering patients to take charge of their own care.”

The FDA document, What to Ask Your Doctor Before Taking Opioids, can be a great way to open the dialogue about opioids and their alternatives. Among the FDA’s suggested questions are:

1. Why do I need this medication — is it right for me? Topics under this general heading that should be addressed between the provider and injured worker are:
   1. How long do you expect it to last?
   2. What medication are you giving me?
   3. If it’s an opioid, are there non-opioid options that could help with pain relief while I recover?”

2. How long should I take this medication? The FDA suggests patients ask their providers to prescribe the lowest dose and the smallest quantity for the average patient. Walls says providers should be even more vigilant, realizing that many patients are not ‘average.’ “If the patient isn’t average, that average low dose may actually be an overdose,” he says. “The only way to find the lowest possible dose is to start with one less.”

3. Can I have a Rx for naloxone? This medication can reverse the effects of an opioid overdose. Walls points out that only high-risk patients should need this, in which case the provider should consider something besides opioids. Also, the injured worker’s caregiver needs to understand that naloxone takes the patient into an immediate withdrawal situation, which requires emergency care.

Summary

In addition to educating workers’ compensation stakeholders about the risks of opioids, injured workers themselves should be made aware of the facts. Information available on some government websites can help providers be prepared to have honest discussions with their patients.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The increasing use of prescription medications places unique challenges on workers’ compensation programs.  Part of the problem is the complex nature of these issues.  This includes the use of “specialty pharmacy” to address the needs of complex matters.

What is Specialty Pharmacy?

The pharmaceutical business is always changing.  One of those changes is the rise in “specialty pharmacy,” which fills specialized prescription drugs, or those that are needed for small groups of patients with complex, chronic conditions. These prescriptions require additional care in their dispensing, handling, and delivery including patient education and training on side effects and self-administration of drugs beyond what is available at a typical retail pharmacy.

Specialty Pharmacy staff including nurses and pharmacists will be trained in complex conditions and treatments to offer patients additional education and resources.

Specialty Pharmacy and Its Impact on Work Comp

According to the latest Express Script’s Workers’ Compensation Drug Trend Report, specialty drugs account for 5.9% of total pharmacy costs, yet account for less than 1% of drugs used by injured workers’.

Specialty pharmacies focus on prescription medications that are not commonly used and dispensed.  These medications usually affect high-risk occupations that have unique challenges.

Some examples of conditions where specialty pharmacy come into play include:

• Hepatitis C infections;
• HIV/AID treatment;
• Various cancers; and
• High blood cholesterol­­­.

Common specialty prescription medications used include:

• Harvoni® (ledipasvir/sofosbuvir): Antivirals (hepatitis C)
• Enoxaparin sodium: Anticoagulants
• Enbrel® (etanercept): Anti-inflammatories
• Truvada® (emtricitabine/tenofovir): Antivirals (HIV)
• Gleevec® (imatinib): Oncology drugs
• Isentress® (raltegravir): Antivirals (HIV)
• Xolair® (omalizumab): Asthma and allergy drugs

Implementing Specialty Pharmacy to Reduce Program Costs

Using a specialty pharmacy as part of your workers’ compensation program is essential for any workers’ compensation program administrator who seeks a competitive advantage in complex cases.  Use of this program can drive down costs and maintain a high standard of care for injured workers with the most complex and chronic conditions.

In the area of specialty pharmacy, the increasing cost associated with lifesaving prescription medications is primarily driven by two factors: an increase in the average cost per prescription, and increased utilization costs associated with specialty pharmacy medications.

Implementation of a specialty pharmacy program should be part of working pharmacy benefits manager relationship with expertise in this area.  Run a pilot program for 60-90 days to evaluate and compare your results to industry benchmarks.

Conclusions

To be successful with complex and chronic conditions, workers’ compensation program administrators and members of the claim management team should be aware of and utilize specialty pharmacies.  This will allow them to properly manage and reduce costs for specialized prescriptions that can cure and relieve the effects of uncommon workers’ compensation injuries.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2018 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.