The Impact of Workers Compensation Compounding

As custom-made compound prescriptions concoctions continue to rack-up higher workers’ compensation costs, insurers are scrambling to find alternatives and employers are looking for relief from equally inflated premiums. With little to no evidence as to the efficacy of such creations, many states have implemented treatment guidelines directing doctors to more evidentiary-based, easily reimbursable options. Despite guidelines and formularies however, loopholes in coverage continue to allow providers to sell millions of dollars of compounds, with many companies submitting inflated reimbursement bills in their attempts to get paid.

A Growing Issue in Workers Compensation

This June, the U.S. Attorney’s Office brought criminal charges against such providers across the country, accusing them of defrauding the Medicare, Medicaid, and Tricare health insurance programs that serve the military and their families. Additionally, the Inspector General of the U.S. Postal Service identified compound drugs as attributable for 34% of the postal service’s prescriptions, and 53% of prescription drug costs in 2015, a rise from 22% and 27% in 2014, respectively. State and federal prosecutors also continue to finger some pharmacies for offering doctor kickbacks in exchange for prescriptions.

Money or medicine?

Industry guidelines point to the use of such compounds as a last resort, accepted in instances where a person is allergic to an ingredient in a drug, or when a liquid version of a commercially available drug is necessary for one who cannot swallow capsules. Some doctors prescribe initially despite these guidelines. The unnecessary prescription of compounds is costing the workers’ comp industry billions annually.

Deep impact

2015 calculations indicate…

• Re-packaged drugs dispensed by physicians cost employers 60% to 300% more than those dispensed at retail pharmacies.
• The average paid per compound drug increased by more than two-thirds from $460.00 to $774.00, though non-compound drugs fell slightly from $113.00 to $108.00.
• The U.S. Postal Service alone spent a whopping $390,000.00 a day for compound drugs in 2015.

Tired of paying more for ineffective treatments?
Proven, more affordable, clinically tested and approved options to compounds do exist. It’s time to find a better way. Discover how to achieve better claims outcomes with ANS Solutions Pharmacotherapy Review. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/the-impact-of-workers-compensation-compounding/

Potential Workers Compensation Cost Drivers- Private Label Topicals

We are seeing a trend in which doctors are increasingly prescribing private label topical drugs for the treatment of chronic pain. Awareness of these expensive and clinically unproven products is becoming increasingly important due to their potential safety and cost implications.

What are they?

Differing from custom compounds, private label topicals are similar to over-the-counter (OTC) topical products, with varying formulations that are not clinically tested for either safety or efficacy. Private-label topical analgesics are not recommended according to evidence-based guidelines and they are not approved by the FDA.

From a clinical perspective, private-label topicals offer no greater benefit to the patient than over-the-counter (OTC) alternatives found in national retail chains and in most cases they are significantly more expensive. The potential cost per prescription is disproportionately high with prices points upwards of several hundred dollars yet these drugs being dispensed by physicians and small, independent pharmacies for the treatment of pain when comparable OTC alternatives such as IcyHot® or BenGay typically retail for less than $10.

Curbing the Issue

When recommending any topical product, whether prescription or OTC, physicians must consider patient safety and evidence-based guidelines. More appropriate, less costly alternative treatment strategies may be available for the effective treatment of pain.  ANS Pharmacotherapy Review can help uncover and address private label drug prescription practices. For more information contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/potential-workers-compensation-cost-drivers-private-label-topicals/

When is a Medical Cost Projection Recommended?

Medical Cost Projections are recommended to establish accurate reserves for the future medical costs of complex, large loss claims, often associated with catastrophic injuries. Catastrophic claims can extend over decades, racking up millions of dollars in medical costs. For this reason, setting an accurate reserve is absolutely critical to the financial well-being and security of the carrier and/or the employer.

Medical Cost Projections and the Complex Large Loss Claims

Oftentimes, large loss claims are highly complicated with multiple factors driving exposure and complex information needing to be weighed. The complex nature of large loss claims can stem from several elements:

• Multiple co-morbidities such as diabetes, multiple infections, respiratory ailments, heart disease.
• Injuries may include fractures that do not heal or develop infections, traumatic brain injuries, spinal cord injuries, amputations, and multiple surgeries.
• Treatment is ongoing resulting frequent reserve increases.
  • Reserves may become exhausted prematurely as a prior review did not include new or increasing exposures.
• Pain management treatment, including high medication utilization with escalating medication costs.
  • May also include the use of pain pumps and/or spinal cord stimulators.
• Ongoing frequent physician visits with multiple providers, possibly creating polypharmacy.
• It is often helpful to develop a Medical Cost Projection when settling a claim with an undocumented worker.
  • Cost Projections can be useful in detailing anticipated future care should the worker intend to permanently relocate outside of the United States.

The volatile nature of catastrophic claims makes accurately setting a reserve no small task. It requires the highly credentialed expertise and comprehensive analysis that a Medical Cost Projection program can provide. At ANS, our national network of highly credentialed nurse experts have extensive catastrophic injury experience and are able to apply jurisdictional specific knowledge to the cases they are strategically assigned.

ANS Approach to Medical Cost Projection

The ANS approach to Medical Cost Projections combines an evaluation of potential areas of exposure with potential areas of savings to provide a complete plan of action. Our findings are independently examined using expert medical and cost data sources. The resulting evidence-based recommendations achieve the best possible outcome from a cost and quality of care perspective. For more information on ANS Solutions’ industry leading approach to Medical Cost Projections, contact us today at www.ans-solutions.com.

This content was originally posted at www.ans-solutions.com.