Phil Walls, RPh
Chief Clinical Officer
As we continue to move into 2021, two of the biggest concerns in workers’ compensation pharmaceuticals remain the ongoing COVID-19 pandemic and the opioid misuse crisis. In this environment, I believe it’s essential for clinical pharmacists to keep a clear focus on the latest developments in these areas. By sharing insight around new drug therapies on the horizon, we can help claims professionals and other industry stakeholders better anticipate the potential benefits and challenges these treatments bring.
Currently, there are three new drugs in the pipeline that I think deserve particular attention. The first represents a promising overdose antidote to the synthetic opioid fentanyl. The others are treatments in development for COVID-19 which could potentially help the large number of patients who continue to be infected with coronavirus, even as we hopefully have turned the corner on the pandemic.
1. Nalmefene — an intriguing potential response for opioid overdose
Illegally manufactured fentanyl is a topic I have written and spoken on previously as it has risen to become the primary drug first responders are encountering in overdose cases. While there is an effective opioid overdose antidote in the form of naloxone, fentanyl represents a unique challenge in that it is 100 times more potent than natural opioids. This has led to numerous situations where a first responder administers a dose of naloxone and it does not work, leading to a cycle of increasing dosages to “out-compete” fentanyl.
Parenteral nalmefene is an opioid overdose antidote that was originally approved by the FDA in 1995, but was withdrawn from the market due to low sales. However, as discussed at this year’s National Rx Drug Abuse and Heroin Summit, there is renewed interest in this drug. One noteworthy development in particular is the current evaluation of nasal administration. This medication has several characteristics that give it potential advantages over naloxone, particularly a longer half-life and quicker onset time. Similar to naloxone, nalmefene is active only when an opioid is present in the system. This means first responders could administer it safely when encountering an overdose, without needing to confirm that an opioid was involved.
Nalmefene offers the potential to streamline the decision-making process for a first responder dealing with overdose symptoms. It remains to be seen if any trends related to nalmefene, such as co-prescribing with opioids, will develop in the workers’ comp space. Because prescription opioids can be a gateway to illicit fentanyl use, those of us in workers’ comp pharmacy should continue to focus on responsible chronic pain management. Prescribers should consider alternatives whenever possible, address behavioral health problems early in the claim and having a weaning strategy in place if opioids are deemed appropriate.
2. Molnupiravir — looking at a possible “Tamiflu for COVID-19”
With the recent announcement that molnupiravir has completed phase two of human trials, there is now a promising new antiviral treatment for COVID-19. While treatments like remdesivir and monoclonal antibodies have been shown to be effective for COVID-19, they have to be directly infused into the blood. Molnupiravir is an antiviral therapy that can be administered orally, removing a primary barrier to delivery.
This could make molnupiravir a COVID-19 analog to oseltamivir, which is marketed under the brand name Tamiflu. By inhibiting the production of the virus, antivirals have the potential to slow down transmission of viruses and reduce the length of an infection for patients. Orally administered and effective antiviral treatments for COVID-19 would represent a major step forward in treatment. We will continue to watch molnupiravir as it moves through the clinical trials process and to determine its potential effect on compensable workers’ compensation cases.
As referenced in the 2020 myMatrixx Drug Trend Report, symptomatic treatment of COVID did not have a major impact on retail pharmacy, representing less than one percent of total spending. As more therapies come to market, our clinical pharmacy team will continue to provide regular updates as we continue to take a vigilant approach to COVID treatment.
3. Ofev has treatment implications for COVID-related pulmonary fibrosis
One of the primary factors that has made COVID-19 such a serious disease is the devastating impact it has on the respiratory system. Patients who develop severe COVID cases are at an elevated risk of a host of respiratory illnesses, including a new illness identified as post-COVID-19 lung fibrosis. This is a form of pulmonary fibrosis, a condition caused by damaged lung tissue, leading to shortness of breath and fatigue that can have a severe impact on long-term quality of life.
Ofev is an oral medication for pulmonary fibrosis treatment currently undergoing a trial at Mount Sinai in New York in partnership with manufacturer Boehringer Ingelheim to study patients with post-COVID-19 lung fibrosis. As many doctors are prescribing this drug off-label in these cases, this trial represents an important step in receiving FDA approval or an emergency use authorization. This would be crucial in removing barriers to coverage, both in group healthcare and workers’ compensation, for what is now a very costly drug for COVID patients.
We’re only just beginning to understand the long-term impact of COVID-19 in the area of retail pharmacy for workers’ compensation cases. Similar to the opioid crisis, we have a long road ahead of us and it’s critical to work together to ensure the best outcomes for patients that promote both safety and value. With programs built on pharmacovigilance, the clinical pharmacy team at myMatrixx can intervene with prescribers to ensure injured workers receive appropriate and cost-effective treatments.