Is Regulation the Answer to Rising Pharma Costs?

National pressure has been building for government regulation on pharmaceutical costs.  A recent poll from the Kaiser Family Foundation found that 72% of Americans think drug costs are unreasonable and demand more transparency from drug companies, especially when it comes to how they set prices.(1) In the face of this discourse, the accountability of pharmaceutical companies has grown as a key focus of recent state and federal regulations.

In the state of Vermont, expensive prescriptions drugs distributed by manufacturers must now justify their exorbitant costs, according to a newly introduced state bill. This new approach, dubbed ‘transparency bills’ stipulates that the information provided by drug makers will be made public, and if they fail to submit, fining will result. It further requires that health insurers provide information to enrollees, potential enrollees, and providers regarding the exchange plans’ drug formularies, including covered drugs, cost-sharing prices, drug tiers, prior authorization, step therapy and utilization management requirements, whose facets are rarely known and understood. Similar measures have also been introduced in other states including California, New York, North Carolina, Oregon, Pennsylvania, Texas, and Virginia.

A debate has been brewing around whether regulation is truly the best solution for pharmaceutical cost containment. Opposing views are camped around the significance of immediate verse long-term effects. Those in opposition raise concerns that such regulation will only produce modest consumer savings while the reduction in pharmaceutical revenues will slow the pace of innovation thus reducing life expectancy and the release of new drugs for future generations. Proponents believe that the benefit of lower prices experienced by consumers now far outweighs these concerns. Influenced by this growing debate, researchers at RAND Corporation examined the impact of drug price regulation in the US. Key findings include(2):

• The regulation of pharmaceutical prices has increased in recent years on a global scale
• Regulation has been seen to reduce pharmaceutical revenues.
• Alternative approaches that reduce consumer costs without affecting pharmaceutical revenues are more likely to benefit current and future generations of consumers.

Ans Solutions specializes in pharmaceutical cost containment that optimizes outcomes for the injured worker while also minimizing financial impact for payers.

Sources

• http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/
• http://www.rand.org/pubs/research_briefs/RB9412.html

Original content posted on http://ans-solutions.com/is-regulation-the-answer-to-rising-pharma-costs/

The Importance of a Multifaceted Approach to Medical Cost Containment

The biggest hurdle in workers’ compensation medical cost containment is that the injured worker is not getting better. Even though WC claims have steadily declined over the last decade, medical costs keep rising as do the sub-par outcomes for the patient and the payer. What we are seeing is that the inter-connectivity of many factors is hindering the end goal of optimized outcomes. A multidimensional approach is crucial not only for combatting pharma costs, but also for ensuring optimal outcomes for injured workers.
At the end of the day medical care cost containment is more than finding savings, it’s also about examining the big picture to help identify potential areas of exposure while enhancing the quality of care and life for the injured worker.
How is this achieved?  Each case has to be approached individually to develop a custom tailored strategy. It has to start with well-established face-to-face communication with the physician. Once the line of communication is open, actionable treatment recommendations backed by evidence based clinical data can be implemented.
The industry also needs to focus on protocols that will ensure better outcomes and appropriate treatment for injured workers. Compliance protocols will result in improved outcomes for all stakeholders.
While medical expenses are the most obvious cost driver, the full picture involves much more than the number of medical services and associated expenses. Quality medical care directly impacts the speed and likeliness of the injured worker’s return to work. ANS Solutions understands the true cost of these practices and has taken an innovative approach to medical cost containment strategies.
Offering an innovative plan to assist payers, ANS Solutions’ proprietary Pharmacotherapy Review offers the integral assistance needed to optimize claim outcomes:

• Expert review of cases by legal nurse experts, noting duplicate treatments and unnecessary/ineffective procedures.
• Actionable, evidence-based treatment recommendations discussed via face-to-face meetings with physicians.
• Ongoing compliance management with the help of clinical liason officers.

To learn more visit http://www.ans-solutions.com today!

 Original content posted on http://ans-solutions.com/the-importance-of-a-multifaceted-approach-to-medical-cost-containment/

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/.

Opioids Still the Top Prescribed Drug in California

Using data derived from the 10.8 million workers comp prescriptions dispensed between January 2005 and December 2014, a recently released report by the California Workers’ Compensation Institute identified opioids as the number one prescribed drug in California’s workers’ compensation system.

Report findings indicate that opioid prescriptions accounted for 27.2% of total prescribed pharmaceuticals. In addition, the average cost of opioid prescriptions rose by 85% from $61 to $113. In comparison, other prescription drugs within the same time frame experienced only a 39% increase, from $94 to $131. The report also indicated the proportion of injured workers prescribed opioids within the first 24 months following injury increased from 22.4% in 2005, to 27.9% in 2010.

Some positive trends were revealed however - in 2014, opioids dispensed to injured workers in the state dropped to 27.2%, from a 2009 peak of 31.9%. Also, the impending implementation of a statewide formulary is expected to contribute to reduced opioid use.

At the end of the day however, opioid use is still excessive. While prescription drug monitoring programs have been a focus of California state regulators, other California Workers’ Compensation Institute studies of utilization review have shown that medical management resources in California have been disproportionately directed to the review of requests for opioids and pain management drugs.

In workers’ compensation pain management, opioids continue to be prescribed in situations where their use may not be entirely appropriate, increasing the patient’s risk of addiction or overdose. ANS’s pharmacotherapy review program has been highly successful in uncovering overprescribing and ineffective management of patient treatment plans not just in California but across the country. The work of our legal nurse experts lays the ground work for pain treatment regimens that reduce the financial costs of large loss claims, while improving quality of care and life for injured workers.

To learn more about are success rate in California, contact ANS Solutions today.

This content was originally posted at http://ans-solutions.com/opioids-still-the-top-prescribed-drug-in-california/

Sources:

Hayes, Steve, Swedlow, Alex. “California Workers’ Compensation Institute: Trends in The USE of Opioids in California’s Workers’ Compensation System,” May 2016.

Putting the Injured Worker First

In the workman’s comp industry, significant effort is put toward breaking the pharmaceutical cost cycle for Payers. As the industry fights for savings, however, injured workers often get lost in the shuffle. The nameless and faceless many among worker’s comp injury statistics are quite removed from the system they rely upon.

Bottom Line Statistics Means Poor Outcomes for Injured Workers

As political pundits fight for special interests, benefit caps are set with no relation to each state’s average weekly wage, ignoring improved wage data and analytical methods that could mend take-home benefits in favor of maintaining the status quo. In addition, research undertaken by the worker’s comp industry often passes over the injured workers themselves, focusing on bottom-line statistics. Typical drug utilization review programs further compound this focus, overlooking patient and prescriber history and offering little to no treatment compliance monitoring, thus yielding poor outcomes for all parties involved.

There is a silver lining however, organizations such as the Workers’ Compensation Research Institute (WCRI), the California Workers’ Compensation Institute, and the National Council for Compensation Insurance are attempting to remove the industry’s blinders with improved studies centered on cost containment and service delivery, offering evidence based data on medications, surgeries and providers in an effort to improve care for patients while curtailing costs.

Ensuring the Best Possible Outcomes

ANS’s Pharmacotherapy Review offers more than clinically-proven drug alternatives that reduce Payers’ costs. Our three pronged approach to claim management is much more comprehensive than the industry standard drug utilization review. Improving the quality of life and care of the injured worker is a driving force behind the development of our proprietary pharmacotherapy review program.

• Focusing on the well-being of the injured worker.
• Consolidating and coordinating drug therapies by multiple prescribers to uncover unnecessary or duplicate treatments.
• Providing alternate therapies with less associated risk factors.
• Uncovering potential risk addiction behaviors.
• Offering weaning programs to help combat the over-prescription of narcotics (opioids).

Embrace change for the betterment of all. Find out more about our innovative drug utilization program today by visiting www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/putting-the-injured-worker-first/

CDC Opioid Guidelines Sheds Light on Conflicting Expert Opinions

The CDCs latest opioid prescribing guidelines, released this March, were created with the goal of achieving balance between the analgesic and addictive properties of opioid analgesics, to uphold the safety as well as meet the pain management needs of the public at large. Unfortunately, the controversy surrounding these guidelines points to a detrimental issue at the crux of their implementation: A fractured field – two expert, yet conflicting, schools of thought on the current opioid policy.

• Treating chronic pain with a wider range of treatments, as opposed to relying mainly on opioid regimens.
• Avoiding the use of high dose prescriptions, as well as the combined prescription of opioids and benzodiazepines, to reduce the risk of overdose.
• Providing addiction treatment when necessary (methadone, buprenorphine).

There are two conflicting schools of thought regarding treatment approaches to opioids…

1. Reduce Pain and Suffering.
   This paradigm stems from an aggressive movement in the 1990s wherein physicians trained in pain management and palliative care were instructed to be sympathetic to pain. Enforced by the belief that those in true pain would not become addicted and reinforced by pharmaceutical companies and federal agencies pointing to pain as “the fifth vital sign,” this movement missed the boat on understanding the serious risks of opioid addiction.
2. Prevent and Treat Addiction.
   Driven by addiction specialists, who lacked an understanding of the seriousness of debilitating and chronic pain and whose priorities were vastly different than pain and palliative care physicians, practitioners of this model had a more thorough understanding of the addictive risks of opioid regimens. They watched the sales of opioid prescriptions quadruple from 1999-2010 - alongside the rate of overdose deaths. Though the need for a rapid public health response remained apparent, insufficient evidence on safe stoppage procedures for opioid regimens existed. Dissention among experts as to the seriousness of the problem and how to address also further muddied the waters.

The Fulcrum between Analgesia and Addiction

Though the CDC’s recently released guidelines are as strong as they can currently be, opioid pain treatment regimens – and addiction treatments – continue to be a work in progress. The fractured nature of this field reflects the reason changes were such a long time coming. A multidisciplinary approach will be as essential to working out the kinks as they were to the development of the CDC’s recently released guidelines, as all parties involved strive to save lives and ensure quality of care.

Are you looking for more advanced and comprehensive medical cost containment strategies that protect patient outcomes while also reducing the costs associated with pain management in workers compensation claims? ANS Solutions’ pharmacotherapy review program can help.

This content was originally posted at http://ans-solutions.com/cdc-opioid-guidelines-sheds-light-on-conflicting-expert-opinions/