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

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©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.

 

Broadspire Drug Abuse Summit and Other News from the Workers Comp Community

 
Broadspire Rx Summit
Danielle Lisenbey, chief operating officer for the Medical Management Services of Broadspire announced its first annual Rx Summit in Sunrise, FL March 22. As a leader in the industry, Broadspire's first Pharmacy Issues Summit should prove to be helpful. They write, “The purpose of the meeting will be to bring thought leaders from various organizations together to discuss relevant topics and issues surrounding pharmacy benefits in the workers compensation setting.

The intent is not to share the specifics of what various companies are doing, but rather to focus on the global industry issues themselves and what may be the possible trends and developments for the future. One key objective of the program will be to help to identify and define common threads that run through all components of the industry – across claimants, payors, employers and carriers.

Defining some of these commonalities will help the consumer to maneuver through the market. Each participant is invited to bring one operations executive and one clinical representative. This will be an opportunity to brainstorm and share ideas amongst industry peers that can help to influence positive impacts for all.”[WCx]

 
 
Email Mjaynes@choosebroadspire.com by March 15, 2012 for more information. The Summit is by invitation only.
 
 
Everything Business Corp! Magazine Tells how to Fuse Workplace Wellness Programs With Recovery
An article by Lisa Firestone addresses the way employers are continuing to struggle with a challenging economy. “Maximizing efficiency and productivity is no longer a goal to strive for, it is essential for continued growth and even survival,” she writes. “Recognizing this dynamic, it is not surprising that more and more employers are actively engaging in worksite wellness programs that have proven to be effective in lowering health care costs – in fact, according to American Journal of Health Promotion every $1 invested in a corporate wellness program returns $4 in reduced health care costs and $5 in reduced absenteeism over a period of three to five years.”
To read more on this topic, look here.
 
 
LexisNexis Communities Highlights Weekly WC Hot Stories
The Workers Compensation Law Community Powered by Larsons on LexisNexis offers this week three fascinating news articles:
 
1. The Defense of Intentional Self-Injury: Russian Roulette, Workplace Frustration, Accidental Drug Overdose, and More reviews Rashness Versus Intention in Self-Injury Cases, Impulsiveness Versus Intention in Self-Injury Cases and Suicide Test as Test for Self-Injury. It can be found here.
 
 
2. LHWCA: Responsible Employer Determination in Cases Involving Multiple Traumatic Injuries: Seeking Analytical Clarity is a thorough look at the same using relevant precedent, post-Albina board decisions, burden of proof; aggravation vs. natural progression: identifying the cause(s) of disability and sequential vs. simultaneous consideration of evidence. It can be found here.
 
 
3. Larson’s Spotlight on Recent Cases: Firefighter’s Rule Did Not Bar Tort Action against Homeowner examines the firefighters’ rule, an important exception to the usual third-party liability rules in which a firefighter (or other first responder) may not recover in tort from a landowner or occupier who has been negligent in starting or failing to curtail a fire. Read more here.
 
 
LexisNexis Editor Featured in Risk Management Magazine
Thomas A. Robinson, a contributing author and editor of LexisNexis resources including Larson's Workers Compensation Law and Workers Compensation: The Survival Guide for Business, wrote a fascinating article that was recently featured in the well-known RIMS magazine. Also a member of the LexisNexis National Workers Compensation Advisory Board, Robinson writes about 10 bizarre WC case that ended unexpectedly here.
 
The article is a great read and includes juicy stories such as what the courts decided when an obese employee broke a leg trying to get unstuck from a cafeteria booth, whether a construction worker who lost an eye trying to sledgehammer a found bowling ball on site and whether a fatal heart attack while holding a termination letter is still covered.
 
 
For more like it, sign up for the free weekly enewsletters in national and California editions by Robin Kobayashi here.
 
 
Need More, Faster WC Info? We have the Newsletter for You
Check out this LexisNexis newsletter that can keep you on top of what’s happening in our industry. Learn more here and sign up here.
 
 
Texas Department of Insurance Changes Pay Advance Form
The Texas Department of Insurance Division of Workers’ Compensation recently changed the form injured employees use to request pay advances on their WC settlement checks. The form, DWC Form-047, Employee’s Request for Advance of Benefits, and the DWC Form-053, Employee Request to Change Treating Doctor is for an injured employee to request an advance of his/her workers’ compensation income benefits. The DWC Form-053 is for an injured employee who is not part of a certified workers’ compensation health care network, and whose claim does not involve medical benefits provided through a political subdivision pursuant to §504.053(b)(2) of the Texas Labor Code, to request a change of treating doctor.[WCx]
 
 
Workers’ compensation system participants should use the revised DWC Form-047 or DWC Form-053 on and after March 7, 2012. Previous versions of the form will no longer be accepted after June 1, 2012. For more information, check here.

 

 

 

 

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.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©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.

Top Industry Exec Offers Workers Compensation Year-In-Review

 
 
Two-thousand-eleven has been an interesting year in the workers compensation industry. New software has helped many administrators take better control of their costs, studies on safety have led to an increase in preventative measures and legal changes have led to unusual and sometimes controversial administration in some states.
 
 
Here at Roundup we asked one of our favorite experts, Curtis Smith, executive vice president of Medcor, Inc., a national on-site health services company, what he thought the top WC issues were for 2011. What follows are his conclusions:
 
Conflicts of Interest Inherent in the Industry
The very organizations employers depend on to help manage and reduce costs depend on claims for their core revenue – and this can lead to potential conflicts of interest, according to Smith. He offers these examples: contingent commissions for brokers and consultants, TPAs (third-party administrators) and MCOs (managed care organizations) who select network providers and share revenue from provider discounts. Smith also cautions against pharmacy chains that put pharmacies on-site in large worksites for convenience also employ the practitioners who write the prescriptions.
 
 
Prescription Drug Abuse
Thousands of people incur illness and injury each year from abuse of prescription medications, especially pain medications. Addictions and overdoses are increasing, as are deaths, Smith wrote. Addictions often arise from treatment after a work-related injuries but the medical community is not policing or restricting doctors who write these prescriptions. What’s more, TPAs are not excluding these unrestricted doctors from networks of approved providers for fear of litigation.
 
 
Prescription Drug Costs
The same medication can cost 10 times as much in workers compensation cases as it does in general health applications. Medications’ fee schedules have been negotiated down and controlled in group healthcare far more than in workers comp situations. Consequently, drug companies and others are moving into the comp space to take advantage of increased profitability, Smith said.
 
 
Increased Litigation in the Industry
The fundamental premise behind the workers compensation system is falling apart in many states (e.g. California and New York) where an increasing percentage of claims are contested and litigated. Huge settlements out of proportion to true economic need are forcing employers to be defensive and deny claims; denying and resisting legitimate claims forces employees to seek counsel and litigate. The comp system is turning into a battleground of plaintiff and defense attorneys working the system.
 
 
Injury Triage
Smith said he would be remiss if he did not mention injury triage. “This truly is an effective way to reduce unnecessary claims and costs, to identify serious cases, and to provide early intervention for all cases,” he wrote. Financial and health outcomes are improved with the use of triage. “It’s also innovative – wining several U.S. patents — are there any other WC methods that have been patented in the last 10 years? Or ever?” he asks. Thousands of companies are using triage and many competitors have joined the market, providing a variety of service and pricing models. Yet, many employers (even most) still don’t use it and the claims-driven industry still resists it.
 
 
Even those who offer injury triage often do so begrudgingly to satisfy their employer-clients, to block another triage provider from taking claims away, or to acquire business – but they are slow to introduce triage to an existing book of businesses, or, once introduced, often let implementation and utilization languish so claims can continue to flow.
 
 
In conclusion, look to hear more about these important topics in 2012. Though they may not be resolved in short order, they are certainly going to be on the minds of those of us in the industry in years to come.
 
Curtis Smith is Executive Vice President of Medcor and can be reached at csmith@medcor.com or 815-363-9500 Ext 5558. Visit Medcor at www.Medcor.com
 
 
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.
 
 
2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©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.

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