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How to curb compounds and related drug costs when the law is silent

My recent curbing compounding post outlined Texas’ regulatory response to the alarming rise in use and cost for compound prescription drugs and the legislation being put in place to curb compounding within the state. While this marks a continued positive trend toward improving quality and effectiveness in injured worker treatment, employers remain exposed to increasing compound drug spend in states that have not yet moved to address the issue through regulations. What can claims administrators do to address compounding concerns in these states?

Consider these four key tactics:

  • Strategic and effective use of prospective and retrospective utilization review
  • Complex pharmacy management
  • Related prescriber and patient education
  • Preemptive direction to responsible prescribers

In states without a strong formulary in place, utilization review can be considered a failsafe for employers. Utilization review, particularly when combined with complex pharmacy management, considers medical and claim history, ensures that prescribing patterns are in line with evidence-based guidelines, and confirms that employees are receiving optimal therapy to facilitate their recovery. When we compared outcomes for Sedgwick customers in Texas using pharmacy utilization review and these other key tactics to address compounds, we saw a 34% reduction in compound drug spend, as compared to the 98% increase outlined in the Texas Division of Workers’ Compensation study, for the same period. The legislation to address compounding in Texas is important, but innovative business and risk management strategies often create useful solutions ahead of legislation.

Our own Texas study also shows that clients with engaged and proactive pharmacy solutions saw a 49% reduction in prescriptions and 40% lower overall prescription drug cost from 2010 through 2016. The recipe for success includes having national pharmacy utilization review protocols supported by a team of specially trained nurses, pharmacists and physicians prepared for peer-to-peer intervention and education. And the process must be fast – best practices show that turnaround time within four hours produces the best results.

Complex pharmacy management should be engaged when adverse medication trends are indicated. Pain coaching, weaning plans, drug compliance testing, drug safety education, peer intervention, and behavioral health intervention are all options to consider in addressing problematic prescribing patterns and unhealthy or ineffective treatment plans. Education is a powerful thing, and employees should be alerted to the lack of proven compound drug benefits. In many cases, we’re seeing injured workers take more control of their medications, whether through education or even just knowing to ask questions of their doctor.

Utilizing providers who have been proven to achieve the most successful outcomes can make a world of difference, regardless of the regulatory environment. Strategically placing injured workers with responsible prescribers – and knowing to avoid providers whose drug prescribing practices indicate adverse drug utilization trends – helps mitigate some pharmacy problems immediately.

It’s hard to argue with the numbers. Nationwide, Sedgwick clients using prescription drug management best practices saw a 25% decrease in prescriptions and a 52% reduction in prescription drug spend. Whether dealing with states that have implemented restrictions on compounding or those that have not, sound pharmacy management and utilization review protocols will give employers and employees an advantage in cost and care.

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