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Docs and drugs – details on the ‘high prescribers’

I wasn’t there, but certainly heard enough about it to wish I was.
I’m referring to CWCI’s annual meeting held yesterday in San Francisco, a meeting that might well have been subtitled “Opioids and the Doctors who prescribe them”.
The report that triggered the excitement (CMS has been asked to review the information, national media has weighed in, and some in the physician community are circling the wagons and attacking the study methodology) was discussed in some detail earlier on MCM; more details on who some of the more ‘liberal’ prescribers were and what they prescribed were presented at the meeting yesterday.
As we get more information on what’s happening with opioid prescribing, the revelations are getting even more frightening, particularly the information about Actiq(r) and Fentora(r), drugs that are only FDA approved for breakthrough cancer pain. Shockingly, there were essentially no diagnoses of cancer in the claimant population
The top 10% of docs who prescribed Schedule II opioids prescribed 84% of the Actiq and Fentora ; turns out that these high prescribers were usually prescribing these drugs for back injuries. (by the way, these drugs commonly cost upwards of $3000 per month…)
Overall, about three percent of doctors treating work comp patients prescribed 65% of the Schedule II narcotics. And, more than half of these scripts were for back strains and sprains.
Meanwhile, in my own home state of Connecticut, we learned this morning of yet another physician caught allegedly using his dispensing powers to enrich himself illegally.
What does this mean for you.
It’s long past time for payers to start working together – or individually – to identify these physicians, find out what’s going on, and take action. We can wait for regulators and law enforcement to act, but in the meantime costs are going up, claimants are dying from overdoses, and the damage to society increases.

9 thoughts on “Docs and drugs – details on the ‘high prescribers’”

  1. Another scary statistic regarding phyisician dispensing of narcotics: 85% of all oxycodone dispensed by physicians NATIONALLY comes from doctors in the state of Florida whose leaders are fighting controls on this practice.

  2. Identifying thses physicians and working toward eliminating these abuses/abusers, nationwide, has become my daily work. Please keep me in the loop!

  3. It’s easy to identify the physicians responsible for these issues. These drugs are controlled substances. The DEA knows exactly who is prescribing them and how much they are prescribing.
    I don’t understand the lack of government intervention on this issue. This problem could be eliminated with two easy things:
    1 Ban off-label pharmacy in workers’ comp. 90%+ of the Actiq prescribed in this country is off label. Almost all of this is workers comp. Group health won’t allow Actiq for a back strain, neither will Medicare. Why is it even allowed in WC?
    2. Shut down the pill mills. There are more people addicted to prescription drugs than illegal drugs. Yet the DEA and other governmental entities focus on the illegal drugs. They spend their time going after the “bad guys” selling cocaine rather than the doctors who are running pill mills. Could this be because the drug companies have better lobbyists than the drug dealers?
    There needs to be more public outrage on this issue. Only when there is outrage will there be political pressure to force action. This is an easy problem to fix. it’s just a matter of getting those with the power to take action to do so.

  4. Yet another example of how the data supplied by insurers is being used but is not accessible to everyone. This should be PUBLIC INFORMATION since it’s being gathered by public entities. While the CWCI may not be a public entity, California’s DWC state reporting data should be publicly available for any and all to use, NOT just the “research” companies who profit from the data.

  5. Realize “public outrag”e can be a great motivator for government to take action against abusers of the system, but if the carriers refuse to reimburse for those scripts on grounds such as “medically unnecessary” or “beyond reasonable & customary” and stand their ground, then maybe the cry of shame would be answered. On the other hand, where is the financial incentive for the carriers to take the lead in any other aspect of the workers’ compensation system than justifying rate increases!

  6. Kevin – appears there’s a misunderstanding here. CWCI’s data is sent to it from its member companies and other entities. For example, the pharmacy data was provided by a PBM.
    This is not the same as the data provided to DWC for state reporting.
    Moreover, this is an excellent example of how data can – and should – be used to improve the entire system. I don’t understand why you object to this.

  7. To R.N.G’s point above- a temporary fix could be adding these drugs to the carriers UM prior authorization grid/list and apply medical necessity criteria. This is easy, just add to the list and file your updated UM plan with the DWC. UR is mandatory in CA but what a payor decides to pre-cert is discretionary. The up-front cost, I beleive is worth it to launch a desparately needed “Sentinel Effect.”
    From the 2011 AOHC meeting in D.C.- steven

  8. Joe, it appears I was misinformed on the role of CWCI and the means in which they obtain data. I stand corrected.
    Thank you for enlightening me on the matter. I appreciate it.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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