Effective Pharma Management Can Help Offset Increases in Prescription Costs

2015 saw rising drug prices contributing to the growth in pharmacy spending for American workers’ compensation payers. Meanwhile, opioid and compound drug cost management continues to be an Achilles heel. An effective pharma cost management program can offset these costs by aiming to improve pain treatment regimens for injured workers.

Pharmacotherapy Review Can Reduce Opioid Spend

Opioids continue to be the costliest class of medications for occupational injuries. To combat the rise in opioid utilization in chronic pain treatment of injured workers, ANS introduced a face-to-face and highly proactive approach to addressing pain physician prescribing practices.  Known as Pharmacotherapy review, it starts with an extensive review of the injured workers’ medical history along with their existing pain treatment regimen and historical physician treatment practices. An ANS Legal Nurse expert with intimate case familiarity visits the doctor in person at their office and negotiates an evidence supported pharmacy regime in a face-to-face and collaborative interaction. The treatment recommendations agreed to during this process not only contribute to reduced opioid prescriptions but often enhance the quality of care and life for injured workers with more risk averse and often more appropriate treatment alternatives.

Combating Rising Compounded Medication Costs

In 2015, the average cost for payers of compounded medications per prescription hovered around $2,000. The cost is high and so are the risks to patients:

• Compounded drugs are not federally regulated and product quality assessments are lacking unlike their FDA-approved counterparts.
• Compounded drugs are not clinically evaluated for safety or efficacy.
• Compounded preparations do not have standard product labeling or prescribing information with instructions for safe use.
• Compounding pharmacies are not required to report adverse events to the FDA
• Potential errors in the preparation of compounded drugs can and have caused adverse effects on patients.

Due to the unnecessary risks compounded drugs pose to patients these products are not considered first-line therapies in the treatment of injured workers. ANS Solutions leads the way in providing medical cost containment strategies that help our clients ensure that pain treatment therapies are appropriate, safe and economically responsibly. By managing compounded medications, clients can reduce unnecessary costs and mitigate the potential harmful effects to patient safety caused by pain physician prescribing habits.

Optimized Financial and Patient Outcomes

ANS medical cost containment programs work uniquely to address these and other legal issues that ensure the most rapid and cost reduced settlement of claims in the industry. Our proven strategies are so effective we offer a 1 million dollar pilot program performance guarantee, completely risk free.  To learn more contact us today or visit www.ans-solutions.com.

 

This content was originally published at http://ans-solutions.com/effective-pharma-management-can-help-offset-increases-in-prescription-costs/

2016 WCRI Annual Issues & Research Conference

ANS recently attended the 2016 WCRI Annual Issues & Research Conference. The independent, not-for-profit institute studies and delivers objective information pertaining to public policy issues involving the workers’ comp system.

Conference Panel Highlights:

• Opioid Prescribing in Workers’ Comp
  • Overview:
    Opioids are a societal problem – not just a workers’ comp issue, and it will take a decade to dig ourselves out. Guidelines are necessary to combat the growing trend.
  • Positive Trends:
    Prescription frequency varies widely by state, leading to revised prescribing guidelines in medical/workers’ comp communities. Retail pharmacies are no longer simply filling, but verifying diagnosis/necessity. The DEA/FDA are also reclassifying some medications to reflect abuse potential, and activist groups supporting change are emerging.
  • Negative Trends:
    A major problem in the workers’ comp arena, the need for early intervention/monitoring is being overlooked by employers, and subsequently programs. Conflicting guidelines also cause confusion. Additionally, use of heroin, the cheaper alternative to prescription opioids, is on the rise.
  • Goals:
    Curtail chronic opioid use and ensure appropriate prescribing of opioids to injured workers and avoid unintended results by boosting awareness of the issue.
• Opioid Dispensing and Use
  • Overview:
    Yet-to-be published studies reveal the impact of pricing reforms for opioid dispensing physicians.
  • Physician Dispensing:
    Following reforms, prices decreased in most states, with fewer prescriptions dispensed. In IL and FL prices substantially increased – because physicians switched to formulations not covered in fee schedules. Price/amounts of pharmacy-dispensed products remained constant.
  • Variations in Use:
    Three-of-four injured workers nationwide receive opioids for pain. LA, NY, and PA dispense significantly higher amounts; NY and PA higher dosages. Patients who received opioids also received benzodiazepines in WI, MI, CT and MA. Per claim amounts decreased from 2012-2014, and frequency of drug testing increased significantly.

As an industry leader in large loss workers compensation claim management, ANS is setting the pace for drug utilization review with our proprietary Pharmacotherapy Review, helping fight the trend of the over-prescription of narcotics. Contact http://www.ans-solutions.com today.

This blog was originally posted at http://ans-solutions.com/2016-wcri-annual-issues-research-conference/

FDA Focuses on Opioid Policy

The FDA has recently acknowledged its own need to establish a “far-reaching action plan to reassess the agency’s approach to opioid medications” in order to reduce the trend, deemed by the U.S. Department of Health and Human Services as “a serious public health issue.” Now the leading cause of accidental death in the U.S., more Americans currently die from drug overdoses annually than motor vehicle crashes, the majority of which can be linked back to opioid prescription medications such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.

National Attention

In addition to spurring the FDA to action, Health and Human Services Secretary Sylvia Burwell identified the boundlessness of the epidemic, citing the importance of both state and federal leaders coming together to form “a coordinated and comprehensive approach to address this crisis.” President Obama has also taken part in multiple efforts to curb the issue, including his 2010 National Drug Control Strategy to address opioid use disorders and overdose, as well as an October 2015 Memorandum to Federal Departments and Agencies calling for improved prescriber training and improved access to treatment for those addicted.

Recent Court Cases Press the Issue

The limelight on opioids has also triggered debate in the political arena, as well as even deeper scrutiny by the medical and workers’ comp communities, particularly following an array of eye-opening court cases in which doctors are being held liable for opioid prescribing practices. The most recent? February 2016’s Tseng Conviction, in which a California general practitioner was sentenced 30 years to life for the prescription of unnecessary painkillers which contributed to the fatal overdose of three patients.

The FDA Proposal to Combat the Epidemic

In response to the crisis, the FDA “has developed a comprehensive action plan to take concrete steps toward reducing the impact of opioid abuse on American families and communities.” Among the steps being taken…

• Advisory committees to review new drug applications, especially for opioids without abuse-deterrent properties.
• New warnings and safety labels to help doctors better understand risks and safe prescription practices.
• Upholding new requirements for drug companies to provide new data on the long-term impact of opioid drugs.
• Improved and updated CME training, including proven uses for opioids and safe prescribing practices, to decrease inappropriate prescriptions.
• Creating/expanding access to abuse-deterrent opioid formulations (ADF) to discourage abuse by spurring innovation, as well as generic formulations, of ADF products.
• A re-examination of the risk-benefit paradigm for opioids to include consideration of the widespread public health effects of drugs.

ANS Pharmacotherapy Review

Our approach to pharma review and intervention is the only face-to-face program of its kind offering evidence-based and actionable treatment recommendations that reduce pharma spend while offering improved quality of care for the injured worker with reduced risk of overdose and addiction. Contact http://www.ans-solutions.com to learn more about our comprehensive pharma review and intervention programs today.

This content was originally posted at http://ans-solutions.com/fda-focuses-on-opioid-policy/

SOURCES:

http://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/

http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

https://www.whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector

http://www.hhs.gov/about/news/2015/09/17/hhs-hosts-50-state-convening-focused-preventing-opioid-overdose-and-opioid-use-disorder.html#

http://www.fda.gov/NewsEvents/Newsroom/FactSheets/ucm484714.htm

http://nationalpainreport.com/commentary-the-debate-over-opioids-should-be-much-more-than-it-is-8829446.html

http://www.consumerreports.org/cro/magazine/2014/09/the-dangers-of-painkillers/index.htm

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/

Innovating Clinical Intervention

The lack of communication among treating physicians for injured workers has been a known deficit in large loss claims for some time. Professional liability insurance companies have recently issued statements concerning the trend of incomplete patient information, missing tests and poor communication among physicians resulting in lengthier recoveries and costly medical treatment regimens.

Current clinical intervention programs embraced by the industry merely scratch the surface of success as they focus solely on a patient’s medication therapy. The reality is that in today’s landscape of multiple doctors and pharmacies, shortened appointments, and conflicting priorities, not all prescribers have the time to conduct an extensive review of a patient’s medical history. Critical factors that can change the trajectory of a claim may be missed such as:

• lab and diagnostic results;
• additional therapies may not have been tried;
• inconsistency in diagnosis between doctors and;
• high risk patient behavior could be present

Optimized Treatment Outcomes through Pharmacotherapy Review

Missed intervention opportunities such as those listed above result in a less than optimal treatment outcome and are often costly. Through the advanced clinical analytical capabilities of ANS nurse experts, our Pharmacotherapy Review program removes the blindfold and brings to light the patient’s full medical history and contributing health factors. The result delivers a complete view of the patient that informs accurate and impactful care decisions. Safety concerns most often uncovered include:

• Duplication of therapy
• Drug-Disease Interactions
• Lack of evidence for use of current treatment therapies
• High dose of medication(s)
• High incidence of side-effects
• Excessive duration of therapy
• Patient age concerns

Our unique Pharmacotherapy Review program provides a holistic clinical assessment to deliver informed and extremely detailed patient recommendations. Recommendations that benefit the outcome of large loss workers compensation claims for the injured worker and the payer alike. To find out more about our medical cost containment strategies contact us today at www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/innovating-clinical-intervention/

6 Ways Pain Management is Mismanaged

There is a significant body of evidence suggesting that many Americans suffer from chronic pain and much of that pain is inadequately or ineffectively treated. Particularly in the case of chronic pain treatment via opioid analgesics, proper chronic pain management is critical in determining whether opioids are used in a manner that is both medically appropriate and in compliance with regulations. Pain management is an important area of patient care that is integral to the practice of medicine, yet so often it is mismanaged. Here we review six most common ways pain is mismanaged:

• Inadequate attention to patient education and informed consent. Deciding to begin opioid therapy for chronic pain should only be made after a physician and patient discuss the risks. Pain patients should have a clear understanding that the clinical basis for the use of these medications for chronic pain is limited, risk of addiction is real, and that taking opioids with other substances or certain conditions (i.e. depression or a history of substance abuse) may further increase risk.
• Inadequate attention to initial assessment. A proper assessment will help to determine if an opioid based pain treatment regime is medically appropriate and necessary. It will also help in uncovering risks associated with use for a particular individual.
• Inadequate monitoring during the use of habit forming medications. Due to its highly addictive and dangerous nature, opioids are associated with drug addiction and abuse. Chronic pain treatment benefit from opioid dose reductions or tapering or weaning off the opioid.
• Excessive reliance on opioids for chronic pain management without adequate attention to alternative treatments. Prescribers should use opioid therapy only when safer and equally as effective alternative therapies prove to be ineffective.
• Baseless dosage increases without adequate attention to risks or alternative treatments. The risks associated with opioids increase with higher doses and even more in conjunction with other comorbidities (i.e. mental illnesses, respiratory disorders, pre-existing substance use disorder and sleep apnea) and with concurrent use with respiratory depressants such as benzodiazepines or alcohol.
• Lack of utilization of available tools or lack of knowledge of available tools for risk mitigation. Our Pharmacotherpay Review program uncovers major issues including duplicate therapies, dangerous or deadly drug interactions, or behaviors related to drug addiction. All of which can have a dramatic impact on a patient’s health.

ANS Pharmacotherapy Review

A well informed physician’s practice can improve safety and the outcome of chronic pain treatment for patients. This is an area where the expert medical cost containment solutions of ANS Solutions can help. Our Pharmacotherapy Review Program provides three highly effective stages that not only contribute to lower medical costs in workers’ compensation claims, but greatly enhance the quality of life and care for injured workers.

For more information, visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/6-ways-pain-management-is-miss-managed/

Abuse Deterrent Opioids a New Era of Opioid Drug Development

The prevalence of opioid use and abuse has led to a new era of opioid drug development: Abuse deterrent (AD) opioids.

The goal?....

Maintain the efficacy of opioid formulations while improving their ability to deter abuse. Following guidelines developed by the FDA to categorize new opioid formulations, pharmaceutical companies are now on a quest to develop tomorrow’s safety net against opioid abuse.

How will the FDA be categorizing these new AD opioid formulations?

1. Physical/chemical barriers
   Physical barriers that prevent the crushing, cutting, grating, grinding, or chewing of opioid formulations, alone or in combination with chemical barriers, which can resist extraction with common solvents (water, alcohol, organic solvents).
2. Agonist/antagonist combinations
   Formulations with the addition of an opioid antagonist, released only when opioid drugs are manipulated. When triggered, the agonists “interfere with, reduce, or defeat” opioid induced euphoria commonly associated with abuse.
3. Aversion
   The addition of a noxious component to formulations to produce an unpleasant effect when opioids are manipulated, or when a higher dose than prescribed is consumed. (For example, a nasal irritant to deter snorting.)
4. Prodrug 
   Biologically inactive substances metabolized inside the body to their active form: That is, the drug must be taken by its intended route and form in order to be properly metabolized.
5. Delivery system
   The implementation of more difficult to manipulate drug delivery systems, such as subcutaneous implants, depot injectable formulations, beads within a capsule, and erodible matrix technology.
6. Combination of 2 or more of the above
   Combining 2 or more of the above methods to decrease the likelihood of abuse.

More questions than answers

Though AD technology is advancing, it continues to carry with it an onslaught of unmet expectations/unanswered questions…

• Is making an uncrushable pill really going to curb opioid abuse when it can be consumed in other ways?
• Why aren't efforts being made to explore more economically responsible, alternative therapies that don't involve any form of opioids at all?
• Will this approach yield enough penetration in the chronic pain treatment community to persuade physicians and patients to switch from their current prescriptions to abuse deterrent forms?

Helping curb the opioid epidemic

Only time will tell how the development of AD opioids will progress and effect the growing opioid abuse epidemic. Fortunately, you don’t have to await developing AD technology to take steps towards making a positive change. Readily available programs, including ANS expert nurse consulting and pharmacotherapy review can help you better address the need of pain patients, providing better outcomes, faster recovery times, and less risk than common opioid treatment regimens.

Ready to be part of the change? Contact ANS today and learn more about how ANS Pharmacotherapy Review can provide superior results for injured workers. Visit us at www.ans-solutions.com for more information.

This content was originally posted at http://ans-solutions.com/abuse-deterrent-opioids-a-new-era-of-opioid-drug-development/