By Melissa Broadman, DO, MPH, Senior Vice President, Pharmacy and Utilization Review, Sedgwick
Opioids may help ease pain after an injury, but the negative impact associated with inappropriate and long-term use raises health concerns that should not be ignored.
At a cost of more than $1.4 billion annually, opioids have become one of the highest cost therapeutic categories for workers’ compensation injuries.1 These powerful drugs present serious patient safety issues and without careful oversight, they can often lead to dependency and abuse.
Here are some additional eye-opening statistics from a recent study published in the Journal of Occupational and Environmental Medicine2:
- Lost time claims with short-acting opioids average 510 more lost days than lost time claims without any opioids at an average additional cost of $45,000
- Lost time claims with long-acting opioids average almost 1,600 lost time days at an average additional cost of $171,000
- Psychotropic drugs added to those claims with long-acting opioids drive average lost time and cost even higher – 1,756 more days off work and $200,000 more
A sophisticated and structured pharmacy claim management process is critical for employers because drug choice dictates the cost and length of claims, as well as short- and long-term employee health and productivity. A pharmacy utilization review program that is integrated into the overall care management process can help employers gain more control.
Ensuring that physicians are following best practices is the key – it is not just about the dollars saved, it is about improving people’s lives. To ensure employee health and safety, employers need a consistent and comprehensive plan for monitoring prescriptions.
Effective programs include clinical review and intervention to prevent or discontinue medications at the point of sale. Sedgwick’s specialty pharmacy nurses are engaged to assess potential problems, and contact providers and discuss alternate therapies where appropriate. Sedgwick’s clinical review team works to ensure that prescribing patterns are in line with evidence-based guidelines and that injured employees are receiving optimal therapy to facilitate their recovery. This type of expert clinical review provides recommendations and documentation regarding the use of inappropriate drugs and potentially life-threatening drug combinations.
The specialty pharmacy nurses collaborate with claims examiners to identify adverse drug trends and develop medication plan strategies. The process removes the uncertainty associated with prescription drug evaluations for examiners, and offers educational communication for injured employees and their physicians. Successful programs also include monitoring for prescriber change management as clinicians intervene with those affiliated with problematic prescribing practices.
Employers should review their pharmacy claim management programs to make sure that they have appropriate interventions at the point of sale, and a consistent process for complex claims with chronic drug use or health safety threats. Programs should focus on drug strength and appropriateness for the injury, prescription length, interactions with other prescription drugs and prescribers involved.
Compound medications should be reviewed by a clinician when they are dispensed. Alerting and engaging pharmacy nurses when compound medication activity occurs allows for targeted interventions, which can prevent long-term use and reduce drug costs.
The impact of all these drugs runs beyond the employers and injured employees. If the prescription medications are not safely locked up, abuse can occur when other people either find them or take them. When you start decreasing the drugs that are dispensed or prescribed, you are also having an exponential effect on the employee’s family, others close to them and the community.
Minimizing the risk of accidental death or the loss of productivity, and supporting the well-being of injured employees and their families are of the utmost importance for employers and society. In the second part of our series being published on May 19th, we will showcase the human component with a real life story highlighting the positive impact of a successful pharmacy utilization review program.
About Melissa Broadman
Dr. Broadman serves as senior vice president of pharmacy and utilization review at Sedgwick where she is responsible for overseeing complex pharmacy management programs developed for employers. She is board certified in internal medicine, and occupational and environmental medicine. She has 16 years of experience and previously served as an occupational health physician in the Chrysler automotive plants and at St. John Occupational Health Partners in Detroit where she evaluated and treated patients with work-related injuries and illnesses. During her career, she also served as an independent and peer reviewer, occupational medicine and disability evaluation physician, fitness for duty evaluator and an urgent care physician. She earned a Doctor of Osteopathy degree from Nova Southeastern University, holds a Master’s degree in Public Health from the University of Michigan, and completed a residency in occupational and environmental medicine at the University of Pennsylvania. Dr. Broadman is a medical review officer and certified medical examiner for the Department of Transportation. She also serves as a delegate to the American College of Occupational and Environmental Medicine and is a board member for the Michigan Occupational and Environmental Medicine Association.
Sedgwick Claims Management Services, Inc., is the leading global provider of technology-enabled claims and productivity management solutions. Sedgwick and its affiliated companies deliver cost-effective claims, productivity, managed care, risk consulting and other services to clients through the expertise of more than 12,000 colleagues in some 275 offices located in the U.S., Canada and the U.K. The company specializes in workers’ compensation; disability, FMLA and other employee absence; managed care; general, automobile and professional liability; property loss adjusting; warranty and credit card claims services; fraud and investigation; structured settlements; Medicare compliance solutions; and forensic investigations. Sedgwick and its affiliates design and implement customized programs based on proven practices and advanced technology that exceed client expectations. Sedgwick’s majority shareholder is KKR; Stone Point Capital LLC and other management investors are minority shareholders. For more, see www.sedgwick.com.
1 NCCI Research Brief “Narcotics in Workers Compensation” (2009)
2 Robert A. Lavin, MD, MS; Xuguang Tao, MD, PhD; Larry Yuspeh, BA; and Edward J. Bernacki, MD, MPH. “Impact of the Combined Use of Benzodiazepines and Opioids on Workers’ Compensation Claim Cost.” Journal of Occupational and Environmental Medicine 56.9 (2014): 973-78.