wed vs progressive
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Progressive Medical: Medication Trends Shaping Workers' CompensationTRANSCRIPT
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
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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
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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
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Insert icon
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Compounded Medica#ons
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Policy Considera#ons
Media A^en#on
Efficacy
Controls
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Opioid Controls and Monitoring Prescribers
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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?
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POLITICAL INFLUENCES IN 2014
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Poli#cal Influences in 2014
Elec#on Year
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ACA Implementa#on
Tepid Economy
Workers’ Compensa#on Rate Pressures
CLINICAL INFLUENCE IN 2014
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Aging Popula#on
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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
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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
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Source: IMS Health Journal Sen#nel
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Why the Decrease in Opioid Analgesics?
Federal and State Guidelines
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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
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Medica#on Agreements
• Statement of Mutual Responsibility
• Explana#on of Medica#on Use • Posi#ve Roadmap for Safety
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U#liza#on is Key
Age Obesity Medica#on Therapy
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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%
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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
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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
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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
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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.
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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
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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
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TOTAL PROGRAM INFLUENCE
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Early capture of prescrip7ons leads to greater control through connected programs.
Total Program Influence
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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
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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
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Analyze Risk
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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
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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
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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
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.
Florida Senator Alan Hays discusses the art of compromise.
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
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