The Right Care
Managing narcotics and problematic drugs in workers’ compensation
Todd Pisciotti, Healthesystems
Interviewed by Troy Sympson
Smart Business Tampa Bay | January 2011
Prescription drugs represent upwards of 15-18 percent of the total cost of medical care for workers’ compensation claims. While the increase in cost has been problematic, managing the use of prescription narcotics has become even more challenging.
In many cases, these powerful drugs can be overprescribed, especially when taking into account their highly addictive nature. In addition, frequently other prescription drugs are needed to address the side effects caused by longer term use, all while more effective alternative treatments may be available.
Combine the overutilization of these drugs with the high prices associated with some of them and the result is very high total drug costs. In most cases, however, the costs associated with an insurance payer’s workers’ compensation prescription drug costs are derived from a small group of claimants, whereby an average of less than 10 percent of claimants receiving drugs drive upwards of 70 percent of the total prescription spend.
“Workers’ compensation drug treatments need to be closely monitored to ensure that the claimant is getting the most effective and appropriate therapy for the right injury,” says Todd Pisciotti, the vice president of sales and marketing for Healthesystems.
Smart Business spoke with Pisciotti about the impact narcotics have in workers’ compensation and the challenges accompanying this prescribing pattern.
What does a typical prescription treatment pattern look like when treating or managing pain for an injured worker?
Depending on the severity, most workers’ compensation injury-related drug treatments are generally short-term — a worker hurts his back, he is treated by a physician and receives a prescription medication to ease the immediate pain, which coincides with other medical therapy. Ideally, the injury improves and the prescription is no longer necessary. However, the more complex injuries can turn into long-term claims and chronic pain cases. Often drug therapy side effects arise from the extended use of certain medications like trouble sleeping, acid reflux, etc. In many instances, other drugs can be prescribed to alleviate these conditions. However, over time this type of issue can escalate, turning into an ongoing drug treatment program involving multiple prescriptions, many times from different physicians, which may not necessarily be a good long-term solution for the injured worker or for the insurance payer.
What types of problems exist and where do they usually begin?
When prescription narcotics are involved, especially powerful and addictive opioids like Oxycontin, problems may exist from the beginning. A general practitioner, who may not usually treat severe acute injuries, may prescribe a narcotic right away, based upon limited knowledge of pain treatment regimens. Perhaps a lesser potent drug would have worked, but if the general practitioner wasn’t familiar with treating pain or didn’t know enough about the particular condition, the treatment could immediately start down the wrong path.
In cases where the treatment is appropriate for the injury, problems can still exist when the drugs start being used for the wrong reasons. Maybe the symptoms or pain have gone away, but the drug continues to be taken for the euphoric effects. Or perhaps, the drug is being diverted and sold on the street. This is why physicians, claims professionals and pharmacy benefit management (PBM) companies need to keep a close eye on treatments from the start. In most cases a pharmacist who dispenses the actual drug doesn’t have all the information available to look at a prescription and say, ‘it doesn’t look like you should have this,’ but the PBM should be monitoring all the prescription treatment data and alerting the claims professionals when it’s necessary.
How do prescribing patterns differ in acute cases versus chronic conditions?
Acute treatments are often ‘one-and-done’ — a quick treatment that’s wrapped up in under 45 days. Chronic treatments are for longer-term conditions, the worst of which can be lifetime. The challenge is identifying characteristics or patterns in acute cases to make sure prescribing doesn’t escalate when it shouldn’t. Sometimes drugs used to treat chronic conditions are prescribed for acute conditions, or are prescribed for off-label use. A good example is the drug Actiq, which is a powerful drug for treating break-through pain in cancer patients. Some physicians began prescribing it for other pain-related treatments outside of cancer. This is highly problematic because the strength and addictive nature of this drug is likely far beyond what is appropriate compared to the alternatives, in addition to the cost, which can exceed more than $2,000 per prescription.
Are the pharmaceutical companies doing anything about narcotics abuse?
Pharmaceutical companies have been actively involved in trying to develop new formulations of pain treatment drugs in order to control abuse. New abuse-deterrent formulations are being created that should render a drug useless if someone tries to boil it, crush it or break it up (in order to then abuse the drug). This is great, but it still doesn’t address issues such as overdose or addiction when the drug is taken in its normal state. Not only that, ‘street chemists’ are pretty intuitive, and it may not take them long to find ways around the abuse-deterrent formulations.
Are there any ways to resolve these issues?
The key to managing the narcotic dilemma is education — making sure the right treatment is being used for the right condition, and that the patient is on the right treatment path. There isn’t a ‘one size fits all’ methodology. PBMs need to watch treatments as they occur and help educate doctors and patients about better alternatives, where available. Being proactive is the way to manage problematic drugs in workers’ compensation cases.