Examining the Effects of Price-Focused Reform

Workers Compensation Research Institute (WCRI) recently conducted a series of studies aimed at examining the effects that federal and state regulations are having on the reduction of pharma spend. What the industry is seeing is an emerging trend in physician prescription reimbursement that begs the question, is price-focused reform effective?

One particular regulation, enacted to cap prices paid by tying the maximum reimbursement to average whole price (AWP) has left physicians in certain states dispensing new drug strengths and formulations at higher prices in efforts to compensate for lost revenue. AWP is set by the original drug manufacturer, however new strengths/formulations are seen as generic, not repackaged. This technical distinction allows the new “manufacturer” to set a new, much higher, AWP, sidestepping reforms. Highlighted in the report, Physician Dispensing of Higher-Priced New Drug Strengths and Formulation, the muscle relaxant cyclobenzaprine, one of several drugs prescribed in this manner, illustrates the effects of such dispensing practices (sales from the first quarter of 2014, post-reform):

• California
  • Typical 5-10mg dose: $0.38-0.39 per pill
  • New 7.5mg product: $3.01 per pill
  • Prescription increase (in same quarter): 55%
• Florida
  • Typical 5-10mg dose: $1.29-1.75 per pill
  • New 7.5mg product: $4.11 per pill
  • Prescription increase: 49%
• Illinois
  • Typical 5-10mg dose: $1.25-1.55 per pill
  • New 7.5mg product: $3.86 per pill
  • Prescription increase: 22%
• Tennessee
  • Typical 5-10mg dose: $1.08 per pill
  • New 7.5mg product: $3.97 per pill
  • Prescription increase: 19%

How can you reduce large loss claim outcomes in the face of these cost drivers?
This trend is driving up medical costs not just in the workers compensation industry, but in the healthcare industry as a whole. With our proprietary pharmacotherapy review, ANS is able to cut through the red tape and provide our clients with quantifiable results. The results achieved not only lower financial costs, but dramatically improve the quality of life and care for the injured worker.

Get on the road to settlement to day with ANS Solutions.

Original Content posted on http://ans-solutions.com/examining-the-effects-of-price-focused-reform.

How Common is Illegal Drug Use Among Pain Patients?

At the American Pain Society’s 35th Annual Scientific Meeting in Austin, findings were released on the use of illicit substances among chronic pain patients. Of 450,081 patients included in a study by Baltimore-based pain medication monitoring firm Ameritox, 10.4% of urine samples tested positive for the use of at least one illicit substance.

How Many of Those Identified Were Workers Comp Patients?
Workers compensation was the primary payer for 22,525 of the 450,081 patients in the study, conducted between January 2013 and July 2015, which showed the use of illicit substances 8.4% of the time in workers comp patients. The group with the highest level of detection, at 16.4%, was Medicaid patients. The lowest: Medicare at 8.1%. Commercially insured individuals were detected at 8.4%, and patient paid tests at 12.5%, respectively. Of those receiving opioid pain treatment drugs, the use of illicit substances was detected at the following rate:

• For patients prescribed Hydrocodone – 10.9%
• For patients prescribed Codeine – 10.7%
• For patients prescribed Oxymorphone – 8.2%

Risk Mitigation and Pharmacotherapy Review
With the use of highly addictive opioids in the treatment of pain, a lack of utilization and/or awareness of risk mitigation strategies is a common driver for poor outcomes. Often times the potential for addiction or the existence of past drug abuse and even behavior consistent with drug abuse are over looked. When this happens the quality of treatment and life in large loss workers compensations claims are severely compromised while associated treatment costs continue to rise.

At ANS, our highly credentialed Legal nurse consultants develop actionable treatment recommendations to enhance the quality of life of injured workers while also ensuring optimal financial outcomes through:

• Comprehensive, holistic medical records reviews and treatment assessments.
• The identification of at-risk individuals and dangerous or deadly drug interactions.
• Uncovering of unnecessary opioid treatment regimens and baseless dosage increases.
• The recommended use of equally effective, less risky, alternative treatment methods where applicable.
• Compliance protocols for monitoring the usage of habit-forming medications, such as opioids.
• Opioid tapering/weaning programs to curb the risk of opioid addiction.

Improve outcomes and reduce costs with the most effective pharma cost containment strategies in the industry. Contact http://www.ans-solutions.com today.

Content was originally published at  http://ans-solutions.com/how-common-is-illegal-drug-use-among-pain-patients/.