By Dr. Mitch Freeman, Pharm.D. Senior Vice President & Chief Clinical Officer, Mitchell
Are you seeing an increase of naloxone prescriptions in your workers’ compensation claims? This may become more common as states move to encourage the co-prescribing of naloxone with opioid prescriptions.
As the U.S. continues to make headway in battling the opioid crisis, naloxone has become an important factor in preventing opioid overdose deaths. The medication, available in injectable, auto-injectable and nasal spray forms, is able to reverse the effects of an opioid overdose. The Food and Drug Administration and U.S. Department of Health and Human Services have announced efforts in recent years to help make naloxone more available nationwide.
States have also taken matters into their own hands, expanding access to naloxone without a prescription. A few states have taken a step further by requiring the co-prescribing of naloxone with an opioid prescription. New Mexico was the latest to enact this type of law, which went into effect in January 2020.
As states and the federal government continue to push to make naloxone more widely available, what do payers need to know about this potentially life-saving drug? Let’s take a look at a couple main questions.
Have efforts by states and the federal government increased naloxone prescribing?
One study by the CDC suggests that, while dispensing of naloxone from retail pharmacies increased between 2012 and 2018, there are still a low number of naloxone prescriptions dispensed compared to the number of high-dose opioid prescriptions (one naloxone prescription per every 69 high-dose opioid prescription). The study found that rural counties were the most affected, with the lowest rates of naloxone dispensing present. However, in the counties where naloxone dispensing was higher, the rates of high-dose opioid dispensing, drug overdose deaths, disability prevalence and Medicaid enrollment, among other factors, were higher. This suggests that in the counties where the opioid epidemic is most acute, efforts are being made to increase naloxone prescribing.
Another study, published in the Journal of the American Medical Association, found that in states that require naloxone co-prescriptions, naloxone was dispensed 7.75 times more than in states without a requirement. At the time of the study, Virginia and Vermont required co-prescribing of naloxone. Since then, Arizona, New Mexico, Rhode Island and Washington have added requirements for co-prescribing.
Is naloxone co-prescribing effective in reducing opioid overdose deaths?
According to the National Institute on Drug Abuse, the risk of opioid overdose has been shown to decrease when a patient is prescribed naloxone with the opioid prescription, even if the naloxone prescription is not filled. These findings suggest that even education on the risk of opioid overdose can help deter overdoses related to prescription opioids.
How does the prescribing of naloxone impact workers’ compensation?
While patient care should continue to be individualized, these studies suggest that the co-prescribing of naloxone can be an effective strategy for high-risk patients. Although the industry has been effective in reducing the number of excessive opioid prescriptions, the drugs still pose a risk to patients who need them to manage pain.
If more states adopt laws requiring the co-prescribing of naloxone, payers should expect to see an increase in naloxone prescriptions in the states that require co-prescribing. Three nuances are important to note here.
- Although some states are beginning to require these co-prescriptions, most do not. As such, the co-prescribing of naloxone with opioids will likely not increase across the board – especially since most states allow the sale of naloxone without a prescription.
- These co-prescribing laws mainly require compliance from prescribers. Payers should work with their PBM to determine appropriate dispensing of naloxone or other opioid antagonists.
- Although previous brand-name prescriptions have been quite expensive, the recent release of generic naloxone nasal spray provides a lower-cost alternative for patients needing a co-prescription.
With these points in mind, work with your PBM to stay up to date on any new laws and to make sure your formulary is set up to promote cost effective formulations where applicable.
About Dr. Mitch Freeman
Dr. Mitch Freeman is the Chief Clinical Officer for Mitchell International, Pharmacy Solutions. Prior to joining Mitchell, Freeman was the CEO of First Coast Health. He has a wealth of industry expertise and leadership in the workers’ compensation industry including the chief sales and marketing officer of PMSI, vice president of sales at Ameritox, vice president and general manager for ExpressScripts, and president of pharmacy services for MSC.
Freeman is a frequent guest speaker and author. Freeman is a graduate of Florida A&M University where he received his doctorate of pharmacy.
Headquartered in San Diego, California, Mitchell International, Inc. delivers smart technology solutions that simplify and accelerate claims handling and repair processes, driving more accurate, consistent and cost-effective resolutions. Mitchell integrates deep industry expertise into its workflow solutions, providing unparalleled access to data, advanced analytics and decision support tools. Mitchell’s comprehensive solution portfolio and robust SaaS infrastructure connect its customers in ways that enable tens of millions of electronic transactions to be processed each month for more than 300 insurance companies, over 30,000 collision repair facilities and countless other Property & Casualty industry supply partners across the Americas and Europe. For more information, please visit mitchell.com.
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