I’m up to my eyeballs in the 13th (!!) Annual Survey of Prescription Drug Management in Workers’ Compensation; the response from payers willing to devote time to the project has been gratifying indeed.
Previous Survey reports are available here; note these are the Public versions; respondents get a much more detailed and comprehensive version.
A bit of background first. I conduct these surveys telephonically, speaking to the individual at the insurer/self-insured employer/state fund/TPA/trust who is directly responsible for the pharmacy program. In addition to asking their opinions and views, we get data on a variety of key metrics including:
- drug spend for 2015 and 2014
- opioid spend for 2015
- compound drug volume
- generic fill and efficiency rates
- mail order usage
A few early findings.
- Pharmacy continues to be seen as more important than other medical ost areas, primarily due to the “downstream” effects of opioids on claim duration, return to work, and related pharmacy spend.
- Most respondents are seeing a decline in drug spend. This is a bit of a surprise, as national research suggests drug costs are going up. A possible explanation is that (most of) these payers are pretty sophisticated, have been working diligently on pharmacy issues for years, and most (but certainly not all) have employed a variety of programs to reduce unnecessary use of potentially dangerous drugs.
- The percentage of spend that goes to opioids varies greatly, from around 21% to over 50%. Some of this is due to regional or state differences, but much is not. Much more to dig into here.
- Mail order continues to be woefully under-used, with most respondents reporting penetration rates in the low single digits. Argh.
- Compound drugs are seen as highly problematic and payers have a wide variety of programs/efforts/mechanisms in place to address compounds.
Much more to come; when the Survey Report is done I’ll post a link.
Enjoy the weekend!
I was hoping in time the pundits against an established (since the inception of Pharmacy) drug modality that has validity, efficacy and safety delivered through the legacy triad of pharmacist, physician, and patient that provides patient-centric therapeutics to individual injured workers, would have “cleared up” the distinction between Private-Labeled Topical Analgesics, Physician Dispensing, convenience packs and other lacking evidence-based drugs such as medical marijuana compared to Non-Systemic Transdermal (NST) Prescription Compound preparations and single NDC commercially available Topical Pain drug products.
As you state Joe, this has not matured to that level yet: “Compound drugs are seen as highly problematic and payers have a wide variety of programs/efforts/mechanisms in place to address compounds.”
The narcotic epidemic, the Return-To-Work issues with systemic absorbed drugs, the studies and evidence of Topical Pain drug products and preparations and the recent Louisiana Court of Appeal in April reversing a judgment and ruling to pay for a NST Prescription Compound preparation based on MEDICAL GUIDELINES for pain should have modified the positioning by the pundits.
“Compound Drugs” and “Compounds” is not the category in dispute. PBM contracted rates, bad actors and the above referenced differentiation to the valid Topical Pain solutions is the “problematic” issues to be addressed.
Once we can identify, define and label the problem appropriately, we will then be able to apply the benefits of Topical Pain solutions to RTW issues and the Opiate Epidemic.
Mr Vega – thanks for the comment. I am not familiar with any credible research documenting improved RTW and “NST” compounds; if you have cites please provide same.
I’d also suggest that a ruling in LA – a rather unique state in regards to the court system and the medical guidelines used in work comp AND the notoriously ill-conceived and poorly managed development and approval process for those guidelines – is unlikely to have any impact in any other state.
Here some studies I was able to find:
Transdermal cream containing Ketamine and Lidocaine was effective in 73% of patients with acute neuro-pathic pain and may be a good alternative to oral medications.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401865/
Compounded transdermal medications have been shown to be effective in the treatment of neuropathic, musculoskeletal, arthritic, and postoperative pain, among other pain-related conditions, and they continue to be explored as a viable alternative option for the management of pain related to a variety of conditions. Compounded transdermal medications effectively reduce pain symptoms while offering a decreased risk of adverse effects commonly associated with oral pain medication, and they may help decrease the risk of drug abuse and addiction. Compounded transdermal preparations for pain management can provide healthcare providers with individualized and potentially more effective options for the treatment of both acute and chronic pain-related conditions.
https://www.esciencecentral.org/journals/pain-management-therapy-the-benefits-of-compounded-transdermal-pain-medication-2329-9126.1000188.php?aid=33304
Neither of these are remotely credible. The “study” was a retrospective chart review evaluating a grand total of 11 patients.
The other was not a study but simply a psuedo-meta-analysis funded by a compound manufacturer.