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Risk managers: Be vigilant in 2017

Make prescription drug control one of your highest priorities

Pharmacy spend has been, and will continue to be, a hot-button topic for a cross-section of the healthcare industry. Workers’ compensation is no exception. Opioids, in particular, continue to be at the center of continual drug safety concerns, with strong potential to impact overall claim costs and, more importantly, the health, wellbeing and productivity of injured employees.


The Centers for Disease Control and Prevention (CDC) reports that overdose deaths involving prescription opioids have quadrupled since 1999. From 1999 to 2015, more than 183,000 people died in the U.S. from overdose related to these drugs. The most commonly abused opioids include methadone, hydrocodone and oxycodone.

Unfortunately, the past misuse of prescription opioids is also the strongest risk factor for initiating the use of heroin. Increased availability, relatively low cost (as compared to opioids), and high purity are also risk factors associated with heroin use. In fact, 9 in 10 people who use heroin also abused at least one other drug.

However, opioids are not the only medications that are easily obtained and abused; musculoskeletal relaxants, benzodiazepines and sedative hypnotics, to name a few, are all commonly overprescribed and easily abused or misused, all of which are frequently utilized in the treatment of workers’ compensation injuries. Neuropathic agents thought by many healthcare providers as benign and free from abuse potential are making the headlines as some of the newest party drugs. Lyrica (pregabalin), classically categorized as a pharmacological anticonvulsant or neuropathic agent utilized for the treatment of fibromyalgia, neuropathic pain, post-herpetic neuralgia or partial onset seizures, has recently been identified as a recreational party drug increasing the number of emergency department visits due to overuse. Beyond the rising misuse of prescription medication, the cost of prescription drugs continues to escalate, making the importance of tight monitoring and close management of the spend associated with pharmacy-related claims a paramount concern on minds of risk managers. A National Council on Compensation Insurance (NCCI) report noted that prescription drug prices increased 11% in 2014 – significantly higher than the 10-year average increase of 4%. NCCI also indicated that prescription drugs account for about 17% of workers’ compensation medical costs.

The following is a list of strategies that can be deployed by employers this year to minimize prescription drug abuse:

  • Deploy aggressive point-of-sale pharmacy clinician intervention
  • Be sure clinicians and pharmacists providing intervention services are armed with the latest drug trends and trained to educate and negotiate with prescribers and injured workers
  • Apply consistent best practice intervention indicators to routinely address complex pharmacy issues and long-term drug use; examples of indicators would be new start long acting opioids or dangerous drug combinations
  • Take advantage of 2017 Drug Enforcement Administration “Take Back” dates by getting employees involved with drug take back initiatives, which include safe drug disposal sites
  • Ensure continual maximum pharmacy network penetration in order to maintain clinical controls across the injured employee population
  • Utilize clinical resources such as pain management contracts, state-specific prescription drug monitoring programs, and urine drug screening to verify and confirm prescription utilization
  • Aggressively manage poly-pharmacy for dangerous medication combinations and unnecessary side effects, including increased sedation, euphoria or opioid induced-constipation
  • Leverage nationally established clinical recommendations, such as the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, American Geriatrics Society Beers Criteria, and state-specific workers’ compensation clinical guidelines, to further reinforce patient-centric safety concerns with prescribers

As always, you can reach out to any of our knowledgeable managed care team at Sedgwick for guidance to help you manage your prescription drug programs.

Shanea A. McKinney, PharmD, Director Client Services-Managed Care Client Services

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