Specialty Drugs in Workers’ Compensation Update
A Population-Based Assessment (2020 Update)
Specialty drugs are typically newer, complex, high-value medications that are rapidly becoming standard treatment for many rare and chronic conditions. According to Information Medical Statistics (IMS) Health, United States specialty net spending rose from 24.7% in 2008 to 46.5% in 2017. Specialty medicines are rapidly approaching half of total drug spend. Across all settings, specialty medicines treat relatively few patients and have costs far higher per patient than traditional medicines.
In this paper, myMatrixx will identify the significant patient populations where specialty drugs are the treatment of choice, including injured workers who have undergone orthopedic surgery, workers who have been exposed to HIV or hepatitis C, patients with conditions such as ankylosing spondylitis and rheumatoid arthritis as well as other key groups. Since these treatments also require enhanced clinical monitoring and medication management to ensure successful outcomes, this report will also cover the important role that pharmacy benefits managers play in this process.
Facts about Naloxone: The Opioid Overdose Rescue Drug: a Clinical Brief Published August 2019
Naloxone is an opioid antagonist that blocks the effects of opioids and reverses an overdose. This medication is an essential tool that can be used in the event of an opioid overdose and has its role in the current opioid epidemic. While it is crucial to implement strategies toward reducing inappropriate use that leads to abuse and addiction in the first place, rescuing patients from overdoses will dramatically reduce mortality associated with opioid misuse.
For this reason, all 51 US jurisdictions have enacted naloxone access laws that remove varying levels of restrictions for naloxone. The next step however, appears to be the enactment of naloxone co-prescribing laws.
The Opioid Crisis and Connecticut’s Workforce
As a person in recovery, it can be a very daunting task to re-enter the workforce. The stigma that surrounds addiction can be very negative and sometimes will prevent a person in recovery from even wanting to go through the hiring process. This document gives several recommendations regarding the tools that are needed by employers to properly navigate the complex world of workers dealing with addiction as well as those who are in recovery.
It’s Not Just Heroin Anymore: Evolving Role of Fentanyl in Drug Overdose
Deaths from heroin overdose increased by a factor of five from 2010 to 2016. However, it has been reported in multiple outlets that many of these deaths are not caused by heroin alone, but instead involve illegally manufactured fentanyl, which can easily be mixed with white powder heroin. Currently, this latest danger in the opioid overdose epidemic has primarily been identified in states east of the Mississippi River. This geographic affect is because white powder heroin is not as prevalent west of the Mississippi where black tar heroin is the predominant form. The black tar heroin is not as easy to mix with fentanyl powder, and as a result, fentanyl is not as likely to be involved in an overdose west of the Mississippi.
Compounds in Comp: A New Look at Patient Safety, Efficacy and Cost
This paper seeks to clear up confusion surrounding compounding medications in workers’ compensation. It clarifies research on the efficacy of compounds and explores how a pricing benchmark that was never intended to be applied to pharmaceutical grade chemicals has been manipulated to drive compounding prices and profits. We examine how certain business practices violate the traditional physician-patient-pharmacist triad, which has safeguarded patient interest for almost two centuries in this country. We also provide updates to legislative and regulatory actions addressing compounding in workers’ compensation. Finally, we examine the consequences of what can most accurately be described as a greed-driven practice that has resulted in tragic deaths as well as the prosecution of numerous physicians and pharmacists.
Creating An Advocacy-Based Claims Model
Business leaders in the healthcare industry invest significant time and resources to create positive corporate cultures, engage employees, and earn their trust and commitment to success. Yet in the workers’ compensation segment of our industry, all too often the focus seems to be on conflict instead of caring. We are in the business of delivering benefits…so, how do we get back to the basics of what workers’ compensation was founded on and change the conversation from adversary to advocate? How do we ensure that the treatment of injured workers aligns with our corporate values and culture? And how could changing the mindset from a cost protection model to a patient protection model improve outcomes–not only for injured workers but for employers as well?
A Brief History of Heroin Use in the United States: Evolving Impact on Rx Drug Abuse
The possibility of injured workers becoming addicted to heroin is quite high. In fact, individuals who were addicted to prescription opioids are 40 times more likely to become addicted to heroin. This paper will first place heroin use in a historical context, examine causes for the current epidemic, and then arm the claims professional involved in the management of workers’ compensation claims with the tools necessary to help prevent the crisis from continuing.
A Guide for Claims Handlers: Specialty Drugs in Workers’ Compensation
Twenty years ago there were only 10 specialty drugs on the market and they were rarely seen in workers’ compensation. Today there are over 300, and drugs such as anticoagulants and antivirals are making their way into claims. There is a great deal of confusion surrounding specialty drugs. What are they? How are they utilized in workers’ comp? Read our Guide for Claims Handlers for an informative overview of specialty drugs.
White Paper: Specialty Drugs in Workers’ Compensation: A Population Based Assessment
Specialty drugs represent the fastest growing category of drugs in the United States and projections indicate that they will account for half of all drug costs in less than five years. In general terms specialty drugs are defined as very expensive drugs that are designed to treat relatively rare conditions. Although prevailing opinion has indicated that many of these conditions, such as multiple sclerosis and hemophilia, will have little impact on drug spending, in workers’ compensation, myMatrixx identifies seven significant patient populations in this white paper in which specialty drugs are the treatment of choice and will most likely be deemed compensable. Read more in our in-depth report.
White Paper: Compounding is Confounding Workers’ Compensation
myMatrixx’s Phil Walls, RPh, Chief Clinical and Compliance Officer, and Michael Nguyen, PharmD are contributing authors to CompPharma’s white paper on the use of compounds in injured workers. The use of compounded drugs has increased five-fold in the last five years, raising questions about their use and their costs. Are they safe? Are they more effective than manufactured drugs? When should they be used? This and much more is covered in this information packed paper.
Case Study: A Look Inside An Opioid Drug Treatment Case
In workers’ compensation, it is commonplace for Pharmacy Benefit Management companies (PBM’s) to inherit catastrophic cases. This study tells of one such claim that myMatrixx faced. Drug therapy costs had reached alarming heights and the claim was in urgent need of intervention. myMatrixx’s Clinical Team approached it with the goal of mitigating risks for both the patient and the insurer. The study reviews a clinical intervention with a case including multiple opioids totaling over $27,000 a month. The case was brought to myMatrixx by Safety National who was concerned about the cost of this regimen as well as health risks for the injured worker. The outcome delivered a savings of over $250,000 per year for the claim.
Navigating Medical Marijuana in Workers’ Compensation
Nationwide employers and insurers are struggling to grapple with the potential effects of medical marijuana in workers’ compensation. Not the least of these is the issue of legality. While on a federal level it is illegal to be in possession of marijuana under any circumstances, 17 states and the District of Columbia have made it legal to use marijuana for medical purposes and similar legislation is currently pending in another six states. Throughout the country, even in states that have legalized its use, federal law prevents doctors from prescribing marijuana. This conflict between state and federal laws raises any number of issues that directly affect the workers’ compensation industry and the workplace as a whole. Despite legalization, it remains to be seen what accommodations employers must make in those states in which medical use of marijuana is allowed. myMatrixx takes an in depth look at this topic in a white paper and the impact it is having on workers’ compensation.
Opioids in the Treatment of Injured Workers: When and How to Maximize Effectiveness
Use of prescription painkillers has increased in staggering proportions compared with other medication classes, in terms of the number of prescriptions written, costs and incidence of overuse and abuse. It has been noted that adherence to guidelines for instituting and monitoring opioid therapy can have a significant impact on cost control in managing the care of an injured worker. The earlier in the claim that insurers are alerted to problems, even to the point of predicting cases in which potential exists, the easier it is to ensure improved outcomes. This white paper will review red flags to look out for and how to identify risk earlier when opioids are used in a patient’s therapy.