WCRI’s just published a comprehensive guide to physician dispensing in workers’ comp, complete with cost trends, state regulations and legislation, individual drug price differentials, and a wealth of other great information.

Here is the key take-away.

• in four states – IL MD FL CA – physician dispensing accounts for more than 55 percent of all drug spend.
• In four more – CT PA TN GA – it accounts for more than 30%.
• and it continues to grow across the board.

What’s notable is that after regulations to limit upcharging for repackaged drugs were put in place in California, the percentage of scripts dispensed by docs didn’t change appreciably.  

With other states, e.g. GA IL MI CT all taking similar action, we will know more about the impact of price controls on dispensing.  My sense is the controls will not significantly reduce physician dispensing.

That is too bad, as CWCI research proves physician dispensing increases medical costs over and above the higher cost of the drugs – while extending disability duration and total claims cost.

All to enrich a few docs and their dispensing company allies.

What does this mean for you?

Higher costs.  Worse outcomes.

CompPharma’s Tenth Annual Survey of Prescription Drug Management in Worker’s Comp is available for download here.

There are two key takeaways from this year’s Survey; the continued decline in drug costs for programs managed by PBMs, and the industry’s sophistication, knowledge, and expertise about all things drug-related.  The latter is one of those findings that is not immediately apparent as it has gradually increased over the last ten years; it is blindingly obvious when one reviews the first Survey and compares it to this year’s.

Respondents’ knowledge of pharmacy is deep and broad; their comments on issues, concerns, and results reflects that knowledge as they discuss issues including:

• the dangers of benzos and opioids prescribed together,
• concerns about opioid addiction and treatment thereof,
• rapid growth in urine drug monitoring,
• safety issues inherent in physician dispensing,
• and drug utilization review functions and programs

For the third consecutive year, respondents reported an aggregate flat or decrease in drug spend.  Careful observers may find this puzzling as overall industry data indicates drug costs are up.  However, the Survey’s respondents all use PBMs, with most taking full advantage of many of the programs and services offered by their PBM.  Perhaps more telling, other data indicates spend on opioids on programs managed by PBMs was also down last year.  

All good, right?

No.  

Senior management remains quite concerned about drugs, with the long term impact of opioids the key driver of that concern. 

And concerned they should be.

We are just about done with our Survey on Opioid Management in Workers’ Comp and there are a few early findings that caught our attention.

(to complete the survey, and register for the iPad we’re giving to one respondent, click here)

About 2/3 of respondents have been in WC for more than 15 years, and about the same percentage work in claims or medical management.  In all, a highly experienced, very knowledgeable group.

The most common first words that come to mind when they hear the word “opioids” are addiction and abuse. 

40% of respondents said senior management is “very concerned” about opioids.

A majority of respondents think payers’ efforts to address opioids have been somewhat or very ineffective; most blame lack of effective regulations.

Payers would like to see regulations: 

• instituting evidence-based clinical guidelines; 
• supporting urine drug monitoring;  and
• requiring opioid agreements/contracts.

Finally, 94% said opioid usage has lead to addiction/dependency.

94%.

Is your hair on fire?

Payers’ views of drug management in workers’ comp have evolved dramatically over the last decade; here are a few initial takeaways from the 10th Annual Survey of Prescription Drug Management in Worker’s Compensation.

We’ve been surveying workers’ comp payers about their views on prescription drug management for ten years now, and the results from this year’s Survey show a remarkable increase in respondents’ expertise, depth of knowledge, and level of sophistication.  The responses to qualitative questions revealed most respondents are far more familiar with all aspects of the drug issue than they were a decade ago.

It is no surprise, then, that costs have declined over the last few years.  While there have undoubtedly been external factors that have contributed to that happy event, there’s also no question that the payers’ focus on this issue is paying off – in lower costs, better care, and reduced premiums.

That said, the looming opioid crisis will require a redoubling of that focus if payers are going to avoid the potentially devastating long-term financial consequences of opioid usage.

Past surveys are available here; a public version of the 2013 Survey will be available next week; I’ll let you know when it is.

It is NO secret that opioids are an issue for the workers’ compensation industry – the cost of the average lost-time claim with long acting opioids 900% higher than those without.

What is a secret is why there’s a picture of an iPad Mini here (see last paragraph for details)…

We do know (thanks to a story published in The New York Times’ June 22, 2013 entitled “The Soaring Cost Of the Opioid Economy,”) the stronger the opioid, the higher the expense of the claim as:

• the average cost of claims without opioids is $13,000;
• the average cost with a short-acting opioid e.g. Percocet is $39,000 (300% of avg.);
• the average cost with a long-acting opioid e.g. OxyContin is $117,000 (900% of avg.); and,
• between 2001 and 2008, narcotics prescriptions as a share of all drugs used to treat workplace injuries jumped 63 percent, according to insurance industry data.

The claims cost while enormous seems small in comparison to the human toll that opioids are taking on families and friends. Opioids are highly addictive and are robbing users of their lives as they knew them and by taking them:

·      U.S. EMERGENCY ROOM COSTS Cases in which an opioid other than heroin was cited as a reason for an emergency-room treatment in 2004 – 299,498 and in 2011 – 885,348 (almost a 300% increase).

·      OVERDOSE DEATHS Where prescription opioids were involved in 1999 – 4,030 and in 2010 – 16,651 (over a 400% increase).

·      DRUGS FOR OPIOID ADDICTION The number of prescriptions dispensed for two drugs increasingly given to treat opioid addiction — buprenorphine and naltrexone — has soared along with opioid use from almost zero in 2002 to 8 million prescriptions in 2012.

·      PATIENTS IN ADDICTION TREATMENT Number of patients in a one-day survey at facilities that use methadone or buprenorphine to treat addiction to pain pills or heroin has risen from 228,140 in 2002 to 313,460 in 2011. (Does not include all patients treated at doctors’ offices.)

What we don’t know is payers’ perceptions, programs, and results.  To that end, we are conducting an online Survey of Opioids and Workers’ Compensation; seeking information about what payers think and are doing about opioids; how opioids are affecting loss costs, claims handling, and claim closure; what management programs are working and what aren’t; the role of the adjuster and PBM; what role opioids should play in worker’s comp; and what the future holds.

Click here to complete the Survey

Couple details –

• all survey respondents get a detailed copy of the Survey Report
• one respondent will get a16Gb iPad Mini in the color of her/his choice
• all responses are confidential

That’s the only conclusion one can reach after reading WCRI’s latest report, The Impact of Banning Physician Dispensing of Opioids in Florida.

Here’s why.

As of July 1, 2011, Florida’s docs could no longer dispense most opioids from their offices.  Before that date, 5.7% of the scripts dispensed by docs were opioids that fell under the ban.

After?  0.6%, and almost all of those were dispensed by docs outside of FL for FL claimants.

Well, we’d expect the volume of pharmacy-dispensed opioids to go up dramatically, wouldn’t we?  After all, no physician would ever prescribe opioids to a patient who absolutely didn’t need them, right?

Wrong.

The volume of pharmacy-dispensed opioids declined.  Went down.  Decreased.

In fact, 3.5% of patients were receiving the stronger opioids from docs before the ban, only 0.5% after (again these were mostly from cross-border trips by FL claimants to out-of-state dispensing physicians).  And the percentage of claimants getting stronger opioids from pharmacies went up by a mere one-tenth of one percent.

Conclusion?

Dispensing docs were prescribing and dispensing strong opioids to many patients who DID NOT NEED THEM.  Why?  For the money.

Opioids are incredibly dangerous.  Opioids kill people.  Destroy families.  Ruin lives.  Addict children.  An intelligent, articulate, promising young woman I know is now a prostitute, selling herself to strangers because she became addicted to prescription drugs.  Her family is devastated, her dreams reduced to the next high.

And these money-grubbing bastards allow this to happen, just to make money to buy nicer cars, better wines, fancier dinners.  

What does this mean for you?

STOP ALLOWING ANY PHYSICIAN DISPENSING.