Can States Surpass Federal & Address Big Pharma?

With some states and areas across the country on the receiving end of opioid painkiller prescription shipments that outnumber the people housed therein, state officials are beginning to address the link between the opioid crisis, Big Pharma, and the heavy burden weighing on their municipalities. In an attempt to hold Big Pharma accountable, they’re taking a page out of past lawsuits against tobacco companies – and suing them.

Key Players

Until now, these multibillion dollar companies have been sidelined in the fight against the opioid epidemic. Now they’re being looked at as star players by city, county, state, and federal officials – even the DEA has taken notice, responding in-kind. This year, in a push to hold opioid manufacturers and distributors responsible, multiple lawsuits have been launched…

States Join Forces in the Fight Against Opioids

Taking the lives of 40 Americans each day, the total economic burden of prescription opioid overdose is costing the country $78.5 billion per year – and these states are taking action…

• Missouri
  Most recently, Missouri’s filed suit against 3 opioid manufacturers, alleging a deliberate campaign of fraud to convince doctors and the public against the highly-addictive, life-threatening potential of the drugs.
• Mississippi
  Suing Purdue Pharma and 7 others, Mississippi lawsuits are borrowing tactics used in their successful fight against tobacco companies in 1998, alleging companies misrepresented the dangers of opioids to doctors and patients, marketing the drug as rarely addictive, and a safe substitute for non-addictive pain medications like ibuprofen or naproxen. But pharmacy companies don’t want the suit to go through – not until FDA-ordered studies on long-term risks/benefits are completed, which could take several years.
• Ohio
  Ohio filed suit against multiple manufacturers for false advertising, Medicare fraud, and violation of the Ohio Corrupt Practices Act, claiming the companies knew (or should have known) their drugs weren’t safe or effective.
• Illinois
  Illinois is taking part in multi-state investigations into manufacturers, with 2 lawsuits in-play. One against Insys, for the deceptive marketing of highly-addictive Subsys for the off-label treatment of back and neck pain in efforts to gain huge profits. Another, an anti-trust suit against the makers of Suboxone, used to treat opioid addiction, alleging a scheme to block generics to artificially inflate prices.
• East Tennessee
  Prosecutors representing 9 counties are taking aim at Big Pharma using the Tennessee Drug Dealer Liability Act, or ‘crack tax’ law. Designed to hold dealers criminally and financially responsible for the effects of the drugs they distribute, the suit labels drug makers as dealers, further accusing them of lying about the addictive properties of opioids, aggressively pushing them as miracle cures for all types of pain. The state AG is investigating its options in pursuing its own legal action.
• New York
  8 NY counties have joined in seeking compensation for expenses caused by the state’s growing drug problem, alleging marketing omitted critical information about the addictive nature of the drugs and risks associated with long-term use.
• Everett, Washington
  They city of Everett filed suit against Purdue Pharma, makers of OxyContin, alleging the company was intimately aware its drug was being funneled into the black market, yet did nothing.

Distributors Sinking, Similar Challenges Against Manufacturers Possible 

CVS, Walgreens, Walmart, McKesson, Cardinal Health, KeySource, Sunrise Wholesale and more are facing charges and paying fines – sometimes multiple times. Some suits have settled. Others have resulted in criminal convictions. Could Big Pharma be next? Though manufacturers vigorously reject the argument they’ve fueled the current opioid crisis, it’s hard to ignore the overdose deaths – more than 300,000 since 1999. But opioids (opium, morphine, heroin) have been around, literally, for centuries, and their highly-addictive properties well-known.

More Lawsuits On the Way

Lawyers currently working these cases note a growing number of jurisdictions showing interest. States are joining forces in the current investigation, with dozens more lawsuits expected. The ultimate hope? That if enough attorneys general are able to join forces in bringing suits, they can accomplish what the federal government has been unable to… And snowball the lawsuits into a massive settlement that might finally put an end to practices that have fueled the deadliest drug overdose crisis in U.S. history.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ compensation insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Sources:
https://www.vox.com/policy-and-politics/2017/6/7/15724054/opioid-companies-epidemic-lawsuits
https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020/
https://www.levinlaw.com/government-opioid-lawsuit
https://www.washingtonpost.com/national/the-drug-industrys-answer-to-opioid-addiction-more-pills/2016/10/15/181a529c-8ae4-11e6-bff0-d53f592f176e_story.html?utm_term=.a364db6d5fe7

Original content posted on http://ans-solutions.com/can-states-surpass-federal-address-big-pharma/

Medical Marijuana Vs. Big Pharma

Increasingly gaining ground as an accepted medicine by top health associations, researchers, and medical journals, the marijuana industry continues its massive expansion, with legalization encompassing more than half the U.S. Predicted to expand nationwide by 2021 by investment firm The Motley Fool, other sectors of the economy are feeling the strain of the industry’s new growth – but no one greater than Big Pharma.

Marijuana & Pharmaceutical Market Share

In an effort to determine how cannabis cash flow is effecting the pharmaceutical industry, researchers at the University of Georgia uncovered just how much of the pharmaceutical pie is being gobbled-up in medical marijuana states – and the results were stark: The average doctor in cannabis-friendly states prescribed 265 fewer dosages of antidepressants, 486 less anti-seizure meds, 541 fewer anti-nausea doses, 562 less anti-anxiety meds, and a whopping 1,826 less doses of pain medications, saving the government’s Medicare Part-D program an estimated $165 million on prescription pills. Taking that total nationwide, an estimated $470 million would disappear from Big Pharma’s annual revenue from this avenue alone.

Expanding Data on Marijuana & Opioids Worrisome for Pharma

A 2014 JAMA study stated opiate overdoses dropped roughly 25% in states with legalized medical marijuana, implying patients may be using it for pain treatment – or to lessen their painkiller load. According to according to the report in Drug and Alcohol Dependence, legalization states also failed to see the expected influx of pot smokers through hospital doors – instead experiencing a decline in hospitalization rates for opioid abuse and overdoses, which dropped 23% and 13% respectively, on average.

Fighting Legalization While Simultaneously Developing Synthetic Cannabis Drugs

This big dip in pharmaceutical purchases is hitting Big Pharma hard, and combined with industry interests, is fueling massive donations to anti-marijuana campaigns, making Purdue Pharma (OxyContin) and Abbot Laboratories (Vicodin) some of the largest contributors to the Anti-Drug Coalition of America. Now infamous, Insys Therapeutics, Inc. (Fentanyl), who currently faces multiple federal and state investigations for aggressive sales and marketing practices, donated $500,000 to Arizonans for Responsible Drug Policy, helping eke out a narrow 51-49 block of Arizona’s 2016 legalization attempt, and making it the only state in which legalization failed in 2016 voting. One of the largest individual contributions to any anti-legalization campaign in history, just five months later Insys won approval for a cannabis-derived pharmaceutical – an anti-nausea drug for AIDS patients – causing cannabis market leaders to reflect on the ethics of Big Pharma’s positioning, and why it has been favored by the DEA and FDA over plants that have already proven effective, safer, and cheaper than prescription drugs.

Stacking the Deck

Few have the resources necessary for this level of lobbying, or to manage the massive fees and extensive oversight necessary to work with the DEA and FDA for testing marijuana usage and product development – but Big Pharma does. It has achieved approval for other drugs in the past, including synthetic THC med Marinol for cancer and AIDS patients. Two cannabis-infused chewing gums by AXIM Biotech now currently await approval for IBS and MS treatment, as well as a topical for eczema/psoriasis. Kannalife Sciences is also developing new drugs for degenerative brain conditions (hepatic/chronic traumatic encephalopathy). Once approved, the drugs are classified separately from Schedule I whole plant marijuana products, their kissing cannabis cousins, and 100% legal with a script.

Are You Ready for a Changing of the Tides?

The workers compensation world is sure to experience turmoil over the upcoming years as changing legislation and front runners in the marketplace scramble for their share of the pie.

About the Author:  Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information visit http://ans-solutions.com .

Original content posted on http://ans-solutions.com/medical-marijuana-vs-big-pharma/

Medical Marijuana and the Workers Compensation Conundrum – Part 1

Because the U.S. Federal Government has dug-in its feet, leaving marijuana as an illegal, Schedule I drug under the Controlled Substances Act, state governments have been left to individually pave their own legalization paths, leaving a frustrated public in the wake. Employers, employees, doctors, workers comp case managers, and more feel frustratingly in-the-dark as ever-diversified, continually evolving legislation continues to change the landscape. This is the first post of our two part series of spotlighting medical marijuana in the marketplace.

What We Do Know About Medical Marijuana

Though state laws vary widely on the amount of legal possession and personal cultivation for medical use, to-date 29 states and D.C. have legalized marijuana for medical use, including 8 states who’ve legalized its use recreationally. For medicinal purposes, marijuana has been scientifically confirmed effective for pain relief, appetite stimulation, nausea control, and reducing ocular pressure. It is arguably cheaper and less addictive than opioids, however both research and quality control are lacking. For injured workers and those in the workers’ comp industry, its most-likely application is pain relief, however it’s typically not be the first drug in the treatment lineup for prescribing physicians.

What’s Murky About Medical Marijuana and Workers' Compensation

Marijuana dispensing differs from run-of-the-mill pharmaceuticals, with product obtained from dispensaries or home growth, not pharmacies, leading to a gap in patient information on potentially dangerous drug interactions. Patient protections also remain muddy. Still illegal under federal law, stateside court rulings are chaotic. Fifteen states offer little to no employee protection, while 11 states explicitly provide protections from retaliatory actions to limits on drug testing from employers. Furthermore, all states with medical marijuana have pending legislation and litigation that could have a broad impact on the workplace, creating a landscape reminiscent of the Wild West.

Who’s Paying For Medical Marijuana Prescriptions?

Who knows? Medical marijuana’s Schedule I status prohibits its inclusion in the National Drug Code, leaving Medicaid and Medicare patients on the sidelines. This lack of regulation also equates to a dearth of coding, complicating processing for pharmacy benefits managers. And state-by-state case law for prescription coverage from employer-sponsored coverage to workers’ comp, like employee protection legislation, also varies widely.

Who’s Got a Headache?

Employers. Though there is federal protection backing drug-free workplace policies, including “zero-tolerance” for specific jobs such as heavy equipment operators, pilots, and surgeons, ever-changing legislation makes it difficult for employers to figure out which end is up. In the meantime, knowledge of state-specific legislation remains key to compliance, with an attitude of managing medical marijuana like any other powerful legal prescription drug that could impair mental capacity a logical choice: Accommodate the needs of injured workers – but uphold a safe work environment, as always. ANS Solutions Medical Cost Containment Programs are the only end to end pharmaceutical cost containment programs in the industry that genuinely put the patient first, while minimizing the cost of settlement in large loss workers’ comp claims. 

About the Author:  Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/medical-marijuana-and-the-workers-compensation-conundrum-part-1/

The Position of Workers Compensation in 2017

With the election of a new president who is ushering in a new era for the government, the trickle-down effect to the workers’ compensation industry just might sweep you off your feet. Prepare yourself with the industry knowledge you need, and avoid being overtaken by the tsunami…

The 2017 Workers’ Compensation Industry Issues to Watch:

• The Affordable Care Act (ACA)
  Like a rogue wave, changes to the ACA may pop-up with little notice. These changes will influence the industry, including claims frequency, claims shifting, and cost shifting if/when private insurance is lost by injured workers, potentially shifting the industry back into the role of “medical insurance for the uninsured.” Preparing for engagement and rapid response to proposed legislation will remain integral as ACA changes are ironed-out in the coming year.
• Nationwide Physician Shortages
  America is projected to be short an estimated 12,000 to 31,000 primary care physicians by 2025, according to the Association of American Medical Colleges. Surgeons are also expected to be in short supply. Though effects will vary based on geographic location, coupled with population growth, the aging Baby Boom population, Affordable Care Act instability, and the nationwide opioid crisis, this single phenomena could converge in a myriad of issues within the workers comp industry.
• Changes to the Workforce
  As the economic current in the U.S. changes, the manufacturing industry may re-emerge, detracting from what is currently a service-based economy. The mobile workforce will also continue to evolve, such as remote and telecommuting positions. Workforce changes aren’t simply labor-related, however, the aging American workforce across the country will also play a large role.
• Prescription Drug Abuse
  The overuse and abuse of prescriptions drugs, particularly opioids, continues to be a turbulent issue in the industry, driving workers’ comp costs and leaving opposing forces facing-off at a line in the sand. As federal and state lawmakers continue to bandage this issue across the medical industry, claims management teams and attorneys will need to move forward in addressing this issue in claims, monitoring prescriptions, recommending “drug contracts,” and better engaging with physicians regarding the risks of abuse, where permitted. On the flipside of the drug abuse coin, the consequences of injured workers medical marijuana scripts influencing on-the-job risks will continue to be a sticky wicket.
• Profit & Loss Scenarios
  Though the workers’ comp industry saw their first underwriting profits in 2013, the trend is not expected to continue. Falling rates and increasing exposures, particularly over the long term, point to a negative outlook overall, with combined ratios of 100% projected for the coming year. Medical providers still continue to increase reimbursement rates to offset costs from lackluster Medicare and Medicaid payments, and medical and pharmaceutical advancements increase the risk of loss. Maintaining proper reserves, conducting timely settlement reviews, and utilizing appropriate resources over the course of the year will be key.

Make Progress in Managing Risks & Costs

No matter how fast the tide rushes in, ground yourself in facing this year’s obstacles with positive change, putting yourself in the best position to avoid being washed out in the chaos. With the transparent, mutually beneficial workers compensation cost containment services of ANS Solutions and our medical cost containment strategies, you can support both financial savings and positive outcomes, with a program that actively engages workers compensation patients with a positive experience, gaining unmatched results via true, face-to-face interactions between all involved parties for a complete team approach to care. Ride the wave of the future, contact http://www.ans-solutions.com today.

Sources:

http://www.wci360.com/news/article/how-to-fix-the-primary-care-physician-shortage

http://www.beckershospitalreview.com/hospital-physician-relationships/15-things-to-know-about-the-physician-shortage.html

Original content posted on http://ans-solutions.com/the-position-of-workers-compensation-in-2017/

Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

• Evzio (2014)
  The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
• Narcan (2016)
  A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at http://www.ans-solutions.com today.

Sources: http://helioscomp.com/docs/default-source/continuing-education-2016/072816-optum-naloxone-use-in-wc-ce_final.pdf 

Original content posted on http://ans-solutions.com/naloxone-narcan-what-workers-comp-payers-need-to-know/

Comorbidities Compound Workers Comp Costs & Recovery

Underlying Conditions Complicate Workers’ Comp Injury Rehabilitation

New research from a Harbor Health Systems study demonstrates the significant impact of underlying conditions on workers’ comp claims. Commonly associated with higher costs and increased duration, this latest research illustrates an undeniable link between patients with comorbidities and undesirable claims outcomes.

A Problematic Pile-Up

Analyzing data from more than 7,000 workers’ comp claims, encompassing seven common comorbidities: Obesity, hypertension, diabetes, mental health, addiction, tobacco use, and combination comorbidities, claims associated with comorbid conditions were found to have incurred an array of undesirable side effects…

• Higher medical costs
  • Multiple comorbidities increased total costs a whopping 341%
• Longer claims duration
  • 76% increase with multiple comorbidities
  • 67% increase with addiction
  • 55% increase with obesity
• More temporary total disability days (TTD)
  • Significantly higher overall in all groups
  • 285% higher with multiple comorbidities
  • 274% higher with addiction
• Increased surgery rates
  • Up 123% with multiple comorbidities
  • Up 140% with obesity
• Increased litigation
  • 147% higher with multiple comorbidities
  • 224% higher with addiction
  • 248% with mental health-related claims

Overall Outlook

While tobacco use had little effect on claims, multiple comorbidities and obesity had the greatest impact on overall, followed by addiction, mental health, and hypertension. Relationships between comorbidities were also found further complicate health and financial risks, with worker age throwing yet another wrench in the works.

Changing Direction

Given these research findings, it is obvious a more comprehensive, systemic approach to workers’ comp claim management is essential to improving treatment results, from a more thorough intake data analysis and the management of multiple health issues addressed by numerous providers and prescriptions, to identifying and finding alternative treatments to those that could result in narcotics abuse.

Quality Matters

Minimizing these risks and providing optimal outcomes for injured workers while controlling workers’ comp costs is no easy feat, and requires a tried and true strategy. ANS Cost Containment Programs work uniquely to address these issues with the only true face-to-face, end-to-end pharmaceutical cost containment program in the industry that genuinely puts patients first while minimizing claims costs through personalized relationships and in-depth case knowledge and review.

Rapid treatment progress and reduced claims costs are possible. Achieve maximum all-around results. Discover how with http://www.ans-solutions.com today.

 

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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/

Prescription Drugs and the Workers’ Compensation Arena

The U.S. remains the biggest global consumer of prescription drugs, up from around 76 million in 1991 to nearly 207 million in 2013 however a recent court ruling has called into direct question the prescription practices of physicians nationwide (Volkow).

The occurrence of unnecessary or medically inappropriate prescribing of opioids in pain management is compromising the lives and well-being of injured workers.  There are a number of serious issues concerning the use of opioids in pain management:

• Not cost effective
  Evidence-based reviews are seldom consulted prior to the prescribing of opioids, and a lack of appropriate physician monitoring and/or patient compliance further contributes to longer recovery periods and increased cost.
• Increased drug-drug interactions
  Polypharmacy, the use of 4 or more medications simultaneously with opioids, can result in drug-drug interactions with severe consequences for patient health.
• Risk for Addiction and Abuse
  The highly addictive nature of opioids leads to the necessity of higher doses over time, resulting in cost increase and greater risk of overdose/addiction. .
• Lack of evidence for proven benefit
  Recovery and return to work rates are not improved by the use of opioids in pain treatment. The American Academy of Neurology and a number of states have released product guidelines advising physicians to proceed with caution when initiating opioid therapy for pain or long-term use.

• Dose dependent risks for serious harm
  Physicians and patients are not always properly educated on use and good faith prescription practices and guidelines, including risks of remaining on disability, addiction, drug-drug interactions, and dosages at which death and risk of overdose dramatically increase.

Where do we go from here?
It’s never been more obvious than now that effective pain treatment must focus on the legitimacy and efficacy of treatments, keeping in mind the quality of care and quality of life of injured workers.  At ANS Solutions our pharmacotherapy review program is focused on protecting the injured worker by:

• Better addressing the needs of pain patients with the assessment of treatment programs and help of evidence based reviews.
• Improving recovery times with the proper monitoring and modifications of treatment.

• Reducing the risks associated with common opioid treatment regimens by consolidating and coordinating drug therapies between multiple prescribers, identifying duplicate therapies and excessive dosages, and pointing out alternate medication regimens.

Positive change stems from a comprehensive and economically responsible approach in the treatment of pain in workers compensation claims settlements. To learn more about pharmacotherapy review contact ANS today.

References

Volkow, Nora D. Prescription Opioid and Heroin Abuse, House Committee on Energy and Commerce Subcommittee on Oversight and Investigations. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse;  April 29, 2014.

Original content posted on: http://ans-solutions.com/prescription-drugs-and-the-workers-compensation-arena/

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.

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/

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/