Prescription drug management is a complex area marked by constant change, requiring continuous evaluation, development and implementation of strategies to stay ahead of current and future trends. The following topics represent just a few of the ongoing and upcoming drug trends that impact workers’ comp pharmacy management.
#1 Pain Pipeline: Novel, Non-opioid Drugs on the Horizon
With treatment guidelines and public opinion pushing back on opioids, current research is exploring non-opioid pathways in the body to treat pain. Notably, in August 2017, the U.S. Food & Drug Administration (FDA) fast-tracked the drug tanezumab, a non-opioid biologic medication for the treatment of osteoarthritis and chronic low back pain – and in 2018 the developers will report data from ongoing phase 3 clinical trials. This is just one example in a deep pipeline of other products in development, which are targeted at blocking pain in the body through non-opioid neural pathways. If these novel pain medications are successful, they have the opportunity to cause a dramatic shift in how pain is managed as prescribers move away from opioids and seek treatment alternatives. Cost will likely be a significant factor, as is typical for first-in-class medications. But first there is significantly more research required to determine the safety and effectiveness of these products.
#2 Specialty Meds: Weighing Cost and Care
Pharmaceutical R&D has yielded a high volume of innovative specialty medications, such as new hepatitis C drugs, biosimilars, and even gene therapy – many of which are making an impact on work comp claims. With some of these therapies priced 40x that of traditional medications,1 cost has been the prevailing concern around specialty drugs. But the specialty discussion goes beyond drug prices to consider critical care decision points that impact overall disease and cost management. For example:
- Will the medication produce better health outcomes? If a specialty drug provides significant clinical benefit over traditional therapy, it has the potential to reduce or even eliminate long-term medical costs associated with chronic and/or advancing disease
- How urgently is treatment needed? For cases where timing is critical, such as prophylactic treatment of workers exposed to HIV infection, there must be protocols in place to ensure timely access
- Is the patient likely to remain adherent? While they can offer significant clinical benefit over traditional therapies, certain specialty medications rely heavily on patient adherence. Nonadherence can lead to consequences that include relapse, increased symptoms, increased costs due to absenteeism or hospitalizations, and in cases such as viral infection, resistance to drug therapy.
- Is the therapy appropriate for the compensable injury? Hyaluronic acid injectable products (Synvisc®, Orthovisc®, Euflexxa®) have a growing presence in workers’ comp claims. These therapies, which are only indicated for the treatment of osteoarthritis (OA) of the knee, can cost $600-1400 or more per script.1 But they also may be inappropriately prescribed off-label for other body parts affected by OA, a determination that may be extremely difficult when diagnosis is unclear or inaccessible to the workers’ comp claims professional.
#3 New & Future Opioids: Higher Cost Without Reduced Risk
Even as research into non-opioid pain medications is underway, new opioid products continue to be developed and approved. Early in 2017, two new opioids with abuse-deterrent properties were approved by the FDA, Arymo® ER and Vantrela® ER, and there are more opioids in development that claim to reduce the risk for adverse effects, including addiction. But thus far, these products have significantly increased costs without effectively reducing patient risk. In 2016, abuse-deterrent opioids represented less than five percent of opioids prescribed in the U.S., yet they reflected $2.4 billion in sales.2 However currently available abuse-deterrent opioids fail to prevent misuse via oral ingestion, the most common form of misuse in the workers’ compensation population. The verdict: so-called “safer” opioids come at a high price without providing additional benefit to the patient.
#4 Trackable Pills: Future Application for Opioids?
Last year the FDA approved the first pill with an ingestible sensor. Abilify MyCite®, a new version of the antipsychotic medication aripiprazole, can digitally record when a medication was taken by the patient. The technology is intended to provide visibility into medication adherence in patients with mental disorders that include schizophrenia, bipolar disorder and depression – conditions in which adherence is critical but often a challenge. Here, there is an obvious parallel with opioids, in which selective adherence and misuse commonly play a role. However, research into how this type of technology can help monitor opioid use is still in very early and limited stages. It also raises questions as far as patient willingness to participate, as well as use of personal data. But given the demand for new solutions to monitor and manage opioid use, this area of pharmacy innovation is one to keep an eye on.
The pharmacy environment is always changing. Having PBM partner with the right clinical experience and consultative services mix can help to deploy differentiated trend management strategies that maximize clinical management and cost containment opportunities.
This is a sponsored post from WorkCompWire marketing partner Healthesystems.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), physical medicine, home health, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
1Healthesystems findings, 2017.