By Paul Peak, PharmD, Director of Pharmacy, Complex Pharmacy Management, Sedgwick
Successful employers have many goals such as helping employees improve their health and well-being, and ensuring overall corporate productivity and competitiveness. An effective pharmacy program can be a valuable tool to help employers with all of these objectives. This type of pharmacy service is designed to prevent or discontinue inappropriate drug use, and it offers benefits for employees with workers’ compensation claims. The programs can improve employees’ lives and productivity, and enhance their overall sense of well-being through intervention and termination of certain drugs.
The injured employee’s experience described below is just one example of how valuable these services can be.
A man injured his lower back while manipulating a hydraulic pump at work. Throughout the course of a long-term treatment regimen, he had been prescribed morphine long-acting and short-acting (opioids), Soma (muscle relaxant) and clonazepam (for anxiety). The daily morphine dose that the patient had been prescribed was 165mg. Because of this high dose, the rules set up in Sedgwick’s claim system triggered a pharmacy review and a complex pharmacy management nurse was assigned to the claim. The nurse reviewed the injured employee’s medical history and prescriptions, and contacted the treating physician to discuss alternatives such as reducing the dosages.
During this same time, the claimant contacted the claims examiner and made her aware that he was not feeling well and not feeling like himself.
The examiner connected him with the complex pharmacy management nurse and he told the nurse the side effects that he was experiencing. The nurse explained that the high doses of the medications and their combined use could be causing the issues he was having. The nurse continued to work to persuade the doctor to consider a different course of action, but the physician did not want to change the drugs that he was prescribing.
The next step for the nurse was to work with the claimant to find a different doctor in the area where he lived. They located a new doctor and the nurse updated him on the claimant’s background and medical issues. The doctor agreed to the prescription changes, which included reducing the pain medication dosage by 40% and tapering him off the other two drugs. These types of medications cannot be stopped abruptly; a patient must be slowly weaned off of them because they are habit-forming and could cause withdrawal symptoms.
After the prescription changes were in place, the claimant contacted the nurse and called her his angel because he felt better than he had in 20 years. He was actually enjoying life again and noted that his friends also saw a big difference. The lower dose resulted in a better quality of life and the fog was lifted. The examiner closed the claim recently and the claimant was somewhat disappointed that he would no longer be hearing from the nurse. She said that he was so appreciative of how the reduced medications helped improve his life.
Sedgwick’s specialty pharmacy nurses work to ensure that prescribing patterns are in line with evidence-based guidelines and that injured employees receive optimal therapy to facilitate their recovery. Our clinical team works in collaboration with our claims examiners to identify adverse drug trends and develop alternate medication plans. Care management strategies that include an aggressive pharmacy program like this can help employers improve the health and safety of their employees, and gain control over prescription costs.
About Dr. Paul Peak
Dr. Peak serves as director of pharmacy on Sedgwick’s complex pharmacy management team. His responsibilities include providing medication guidance and consulting for Sedgwick’s clinical team. He also works closely with claims examiners and specialty pharmacy nurses as a part of the company’s complex pharmacy management program. Previously, he served as pharmacist in charge for Advantage Pharmacy in Memphis. Dr. Peak has nine years of experience and has also worked as a staff pharmacist in both the hospital and retail environments. He earned a Doctor of Pharmacy degree from McWhorter School of Pharmacy at Samford University.
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.