Progressive Medical: Medication Trends Shaping Workers' Compensation

1. MEDICATION
TRENDS
SHAPING
WORKERS’
COMPENSATION
Na#onal
RX
Abuse
Summit
2014
2014

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Presenters
Brian
Allen,
Vice
President,
Government
Affairs
Tron
Emptage,
R.Ph.,
M.A.,
Chief
Clinical
Officer
2

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Discussion
Points
Policy
Influence
on
Pharmacy
Benefits
Poli#cal
Influence
Clinical
Influence
Product
Influence
Future
Influence
The
Art
of
Compromise
Q&A
3

4. POLICY
INFLUENCE
ON
PHARMACY
BENEFITS

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Physician
Dispensing
• Cost
– Repackaged
Medica#ons
– Loss
of
Managed
Care
Benefits
• Outcomes
– California
Study
– WCRI
Study
• Scope
of
Prac#ce
Debates
• Poli#cs
5
Insert icon

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Compounded
Medica#ons
6
Policy
Considera#ons
Media
A^en#on
Efficacy
Controls

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Opioid
Controls
and
Monitoring
Prescribers
7
Poli#cs
of
Controlling
Prescribing
Closed
Formularies
Media
A^en#on
PDMP
Impact

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Marijuana
Recrea7onal
• Washington
• Colorado
Medicinal
• Utah
What is the impact on Workers’ Compensation?
8

9. POLITICAL
INFLUENCES
IN
2014

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Poli#cal
Influences
in
2014
Elec#on
Year
10
ACA
Implementa#on
Tepid
Economy
Workers’
Compensa#on
Rate
Pressures

11. CLINICAL
INFLUENCE
IN
2014

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Aging
Popula#on
12
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
80,000,000
90,000,000
100,000,000
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
Popula7on
65+
by
Age:
1900-­‐2050
Source:
U.S.
Bureau
of
the
Census
Age
65-­‐74
Age
75-­‐84
Age
85+
Source:
www.aoa.gov,
Projected
Future
Growth
of
the
Older
Popula#on

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Obesity
in
the
United
States
13
SOURCES:
CDC/NCHS,
Na#onal
Health
Examina#on
Survey
I
1960–1962;
Na#onal
Health
and
Nutri#on
Examina#on
Survey
(NHANES)
I
1971–1974;
NHANES
II
1976–1980;
NHANES
III
1988–
1994;
NHANES
1999–2000,
2001–2002,
2003–2004,
2005–2006,
2007–2008,
and
2009–2010.
Accessed
via
www.cdc.gov
January
2014.
Trends
in
overweight,
obesity,
and
extreme
obesity
among
men
aged
20–74
years:
United
States,
1960–1962
through
2009–2010

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Opioid
U#liza#on
Declines
for
Second
Year
14
Source:
IMS
Health
Journal
Sen#nel

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Why
the
Decrease
in
Opioid
Analgesics?
Federal
and
State
Guidelines
15
Abuse
Deterrent
Formula#ons
REMS
Programs
Urine
Drug
Monitoring
PDMPs

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Opioid
Monitoring
Tools
Urine
Drug
Tes#ng
State
and
Na#onal
Drug
Monitoring
Databases
Pill
Counts
16

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Medica#on
Agreements
• Statement
of
Mutual
Responsibility
• Explana#on
of
Medica#on
Use
• Posi#ve
Roadmap
for
Safety
17

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U#liza#on
is
Key
Age
Obesity
Medica#on
Therapy
18

19. PRODUCT
INFLUENCE

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Product
Claim
Medica#on
Trends
2013
RANK
MEDICATION
NAME
PERCENTAGE
OF
TOTAL
SPEND
1
ANALGESICS-­‐NARCOTICS
31.0%
2
ANTICONVULSANT
11.7%
3
ANTI-­‐RHEUMATIC
9.5%
4
ANTIDEPRESSANTS
8.4
%
5
DERMATOLOGICAL
8.2%
6
SKELETAL
MUSCLE
RELAXANTS
6.2%
7
ULCER
DRUGS
3.0%
8
HYPNOTICS
2.8%
9
ANTIASTHMATIC
2.3%
10
ANTIPSYCHOTICS
2.3%
20
Top
10
Therapeu7c
Classes
2013
RANK
MEDICATION
NAME
PERCENTAGE
OF
TOTAL
SPEND
1
OXYCONTIN
TABLET
7.6%
2
LIDODERM
PATCH
5.3%
3
CYMBALTA
CAPSULE
5.1%
4
LYRICA
CAPSULE
5.1%
5
CELEBREX
CAPSULE
4.0
%
6
NEURONTIN
3.9%
7
NORCO
T
TABLET
3.8%
8
PERCOCET
TABLET
3.4%
9
DURAGESIC
PATCH
2.7%
10
OPANA
ER
TABLET
1.7%
Top
10
Medica7ons
*All
other
classes
combined
represent
10.71%

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Generic
Efficiency
21
Percentage
of
7mes
a
generic
was
dispensed
versus
the
number
of
opportuni7es
for
generic
dispense
Generic
efficiency
is
more
meaningful
than
generic
fill
rate
as
it
is
not
swayed
by
an
introduc#on
or
removal
of
generic
medica#on
from
the
market.
Recent
or
Upcoming
Generic
Releases:
• LidoDerm
5%
Patches
• Aciphex
• Cymbalta
• Exalgo
• Lunesta
• Nexium
• Zyvox
• Celebrex

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1.0%
INCREASE
IN
GENERIC
UTILIZATION
EQUATES
TO
1.8%
REDUCTION
IN
SPEND

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Compound
Medica#on
U#liza#on
23
2012
0.53%
of
all
prescrip#on
medica#ons
3.81%
of
total
drug
spend
2013
0.60%
of
all
prescrip#on
medica#ons
2.08%
of
total
drug
spend

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Common
Topical
Ingredients
On
average,
there
are
four
to
five
individual
ingredients
in
compounded
medica#ons.
Therapeu7c
Classes
Commonly
used
agents
NSAIDs
Ibuprofen,
Diclofenac,
Ketoprofen,
Flurbiprofen
Opioids
Tramadol
Local
anesthe#cs
Lidocaine,
Benzocaine,
Ketamine
An#depressants
Amitriptyline,
Nortriptyline
An#convulsants
Gabapen#n,
Lyrica
Skeletal
muscle
relaxants
Cyclobenzaprine,
Baclofen
Other
topical
analgesics
Capsaicin,
Menthol,
Methyl
Salicylate,
Clonidine
24

25. 25
FUTURE
INFLUENCES

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Zohydro™
ER
• Zohydro
ER
is
indicated
for
the
management
of
pain
severe
enough
to
require
daily,
around-­‐the-­‐clock,
long-­‐term
opioid
treatment
and
for
which
alterna#ve
treatment
op#ons
are
inadequate.
• Approved
by
the
Food
and
Drug
Administra#on
(FDA),
it
is
the
first
extended-­‐
release
hydrocodone
only
pain
reliever
available
in
the
United
States.
• Schedule
II
substance;
a
new
prescrip#on
is
required
for
every
fill.
• Its
formula#on
does
not
include
abuse-­‐deterrent
proper#es
and
risk
poten#al
has
sparked
public
outcry
and
vigorous
debate.
• Our
posi#on
is
that
the
risks
associated
with
this
new
medica#on
likely
outweigh
the
benefit
and
we
are
strongly
recommending
that
our
customers
either
exclude
this
medica#on
from
their
customized
Medica#on
Plans/Formularies
or
at
a
minimum
require
Prior
Authoriza#on
as
is
consistent
with
our
standard
approach.
26

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Medical
Marijuana
Legaliza#on
among
mul#ple
states
is
genera#ng
conversa#on
• Employer
challenges
include
– A
heightened
level
of
concern
when
an
injured
worker
returns
to
a
safety-­‐
sensi#ve
occupa#on,
such
as
driving
or
construc#on,
while
subject
to
the
poten#al
adverse
cogni#ve
and
psychological
effects
of
marijuana.
– Quan#fica#on
of
the
amount
of
marijuana
consumed
by
the
injured
worker
is
not
available
through
urine
drug
tes#ng,
thereby
limi#ng
the
ability
to
determine
if
he
or
she
has
consumed
the
prescribed
dose,
or
is
in
fact
acutely
intoxicated.
– Understanding
the
poten#al
impact
to
Drug
Free
Workplace
policies
as
well
as
other
safety
and
risk
management
protocols
and
programs
• Based
on
the
best
available
scien#fic
evidence
and
recommenda#ons
at
this
#me,
its
classifica#on
as
a
Class
I
substance
and
the
lack
of
an
assigned
NDC,
medical
marijuana
remains
excluded
from
our
Medica#on
Plans/formularies
27

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Medical
Marijuana
is
legal
in
20
states
• Medical
Marijuana
is
legal
in
20
states

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Interdisciplinary
Rehabilita#on
Programs
“The
gold
standard
of
treatment
for
individuals
with
chronic
pain
who
have
not
responded
to
less
intensive
modes
of
treatment.”
–
USDHHS
(Na#onal
Guideline
Clearinghouse)
• Collabora#ve
Processes
• Evidence-­‐based
Medicine
• Ongoing
Communica#on
• Concurrent
Execu#on
• Shared
Problem
Solving
29

30. TOTAL
PROGRAM
INFLUENCE

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Early
capture
of
prescrip7ons
leads
to
greater
control
through
connected
programs.
Total
Program
Influence
31

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Quicker
access
to
informa7on
be^er
equips
claims
professionals
and
clinicians
to
make
decisions.
Early
capture
of
prescrip#ons
Total
Program
Influence
32

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Quicker
access
to
informa#on
Early
capture
of
prescrip#ons
Mul7-­‐factor
risk
analysis
based
on
pharmacy
behavior,
the
injury
and
overall
demographics
should
be
applied
to
be^er
predict
the
path
of
a
claim.
Total
Program
Influence
33

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Analyze
Risk
34
Predic#ve
power
of
variables
change
over
#me
Percent of Significance (aggregated across multiple variables)

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There
will
always
be
claims
that
mature
into
complicated
situa7ons.
Clinical
Tools
• Claims
Professional
Outreach
• Physician
Outreach
• U#liza#on
Reviews
• Interven#on
Reports
• Peer-­‐to-­‐Peer
Review
Total
Program
Influence
35

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Key
Outcomes
• 1.7%
reduc7on
in
overall
prescrip7on
cost
per
claim
Opioid
Analgesics
• 7.2%
reduc#on
in
overall
narco#c
spend
• 5.5%
reduc#on
in
overall
days
supply
• 5.6%
fewer
overall
scripts
• 10.6%
reduc#on
in
overall
MED
36

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A
total
program
solu7on
consis#ng
of
comprehensive
data,
risk
analysis
and
clinical
tools
will
greatly
decrease
the
likelihood
of
a
long-­‐term
claim

38. THE
ART
OF
COMPROMISE

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Compromise
is
a
way
of
life
and
occurs
in
nearly
every
interac#on,
both
in
our
personal
and
professional
lives.
We
do
it
every
day.
As
Florida
Senator
Alan
Hays
a^ests,
when
both
sides
are
willing
to
give
a
li^le
bit,
the
result
will
likely
be
an
even
beaer
solu7on.

40. Florida
Senator
Alan
Hays
discusses
the
art
of
compromise.

41. THANK
YOU
Ques#ons?

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Contact
Us
Brian
Allen,
Vice
President,
Government
Affairs
Brian.Allen@progressive-­‐medical.com
Tron
Emptage,
R.Ph.,
M.A.,
Chief
Clinical
Officer
Tron.Emptage@progressive-­‐medical.com
42