June 19, 2018

Drug Utilization Management: Have You Tapped Its Full Potential?

Managing appropriate utilization of prescription medications is a critical component of balancing quality and cost of care in workers’ compensation. The concept seems intuitive: by delivering the most appropriate care to a patient, you’ll also come out ahead from a cost perspective – with better outcomes, shorter claim durations, a lower likelihood of chronic treatment, and fewer complications requiring additional treatment. But all too often utilization management tools are not applied in a way that fully takes advantage of their potential. There is a significant opportunity to enhance the application of these tools to better control costs and improve patient care.

Earlier and more aggressive application of utilization management tools can prospectively manage patient risk to dramatically impact claim durations, outcomes, and costs. The key to success is the ability for the claims professional to take quick action. And this requires a comprehensive utilization management strategy that deploys tools as needed throughout the care continuum. Many of these tools are more powerful enhancements to the traditional way of doing things. For example, if there is concern regarding a prescribed medication, intervening with the prescriber at prior authorization can initiate early dialogue around clinically appropriate alternatives. This proactive approach results in a prescription change in 2 out of 3 cases1. And this is just the tip of the iceberg when considering the long-term patient safety and financial benefits of avoiding inappropriate or high-risk medications within a claim. There are a number of patient risk factors that can arise at any point during a claim lifecycle, and these risk factors can translate into significant dollars when not managed efficiently and aggressively.

Consider the opportunities for intervention:

  • Adding benzodiazepines to a short-acting opioid regimen can triple the average claim cost ($43,438 vs $123,311)2
  • Opioid misuse, abuse or dependence cost payers an extra $15,000 or more per patient, per year3
  • Claims with long-acting opioids are nearly 9x as likely to cost more than $100,000 than claims without opioids present4
  • Compounds and private-label topical products are not clinically proven for safety or efficacy, and can cost thousands of dollars for a month of treatment
  • Opioid-induced constipation (OIC) can double the total healthcare costs in the first year following opioid initiation5
  • Opioid-related drug interactions can incur an additional $600 per month, per patient6

The fact is, these are all concerns that can be addressed before they even happen. It is just a matter of having the right strategy.

Do you have an effective utilization management strategy that truly maximizes its fullest potential with the right supporting tools? Look for the article “Making the Most of Utilization Management” in our upcoming issue of RxInformer journal to see how earlier and more aggressive application of utilization management tools can dramatically improve patient care and cost.

Sign up for free at www.healthesystems.com/rxinformer and be among the first to access the new issue when it debuts in November.

Partner Post:
This is a sponsored post from WorkCompWire marketing partner Healthesystems.

1 Healthesystems data.
2 Lavin RA, Tao X, Yuspeh L, Bernacki EJ. Impact of the combined use of benzodiazepines and opioids on workers’ compensation claim cost. J Occup Environ Med. 2014;56:973-8.
3 White AG, Birnbaum HG, Schiller M, et al. Economic impact of opioid abuse, dependence, and misuse. Am J Pharm Benefits. 2011;3:e59-e70.
4 Tao X, Lavin RA, Yuspeh L, et al. The association of the use of opioid and psychotropic medications with workers’ compensation claim costs and lost work time. J Occup Environ Med. 2015;57:196-201.
5 Wan Y, Corman S, Gao X, et al. Economic burden of opioid-induced constipation among long-term opioid users with noncancer pain. Am Health Drug Benefits. 2015;8:93-102.
6 Pergolizzi JV Jr, Ma L, Foster DR, et al. The prevalence of opioid-related major potential drug-drug interactions and their impact on health care costs in chronic pain patients. J Manag Care Spec Pharm. 2014;20:467-76.

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