By Dr. Mitch Freeman, Pharm.D. Senior Vice President & Chief Clinical Officer, Mitchell
Is your clinical program running at its best? When there are so many changes to track, from clinical and regulatory to business perspectives, it can be easy to overlook certain factors that could help optimize your program. As we continue into the new year, what should you be considering?
Here are three key questions to ask about the utilization and prescribing patterns in your program:
What is your brand utilization?
As you evaluate your pharmacy program, look closely at the ratio of brand to generic medications that are being filled. Are there gaps? Two areas to look at are:
- Medications that have a generic available that can be substituted with the right physician intervention.
- Medications that do not have a generic available but have equally efficacious alternatives for a lower cost.
Paying close attention to these two areas can help your team to control the balance of brand to generic prescribing.
Another important factor to consider is drugs turning generic. Do you know the latest brands to turn generic and how you should be addressing prescriptions for these drugs? One major medication that went generic in 2019 was Lyrica. Evaluate if your program is still paying for large quantities of the brand name drug and why that might be. Consider whether it is appropriate to switch patients to the generic formulation and how to reduce the number of new prescriptions for the brand drug.
One area that may be preventing a decrease in brand prescriptions when a generic is available is prescribers’ use of Dispense as Written (DAW) on the prescription. Although formularies typically substitute a generic for a brand medication when appropriate, if DAW is written on a brand prescription, the pharmacist will dispense the brand. Consider employing physician intervention to potentially switch patients to generic medications, where appropriate.
What methods can you continue to employ to combat opioid overprescribing?
The workers’ compensation industry has made strides to control the opioid crisis, with measures in place to screen inappropriate prescribing patterns and promote the best possible care for injured workers. As we continue these efforts, what methods can be successfully utilized to reduce overall opioid prescribing?
A study by WCF Insurance and Mitchell showed that early intervention on prescribing of opioids is helpful in preventing claims from becoming long-term use claims or spiraling out of control. The study found that physician education on prescribing patterns also helped reduce the number of claims receiving opioids. Overall, the program employed was able to reduce opioid first-fill prescribing by 56% for WCF claimants in the state of Utah.
For claims that already have opioid prescriptions, intervention with the prescribing physician is key. Payers can guide the physician to prescribe within guidelines at appropriate MED levels and to evaluate whether to ween the patient off opioids altogether.
As you continue to reduce opioid prescribing, are you considering other medications that could play an important role in your pharmacy program?
With a large amount of focus directed at controlling opioids, other medication utilization can sometimes sneak up. As you work to optimize your program, make sure you are aware of other medications that are topping your utilization and spend list, and consider whether closer evaluation is necessary.
Some questions to ask:
- What medications are now topping your list of utilization and spend?
- Should there be any concern in the prescribing patterns of these medications?
- What methods can you use to reduce unnecessary prescribing, if any, of these medications?
- Have you considered the implications of medical marijuana or other potential new drugs to enter the market?
- Has your PBM partner helped you to identify potential gaps and strategies to improve?
The workers’ compensation industry and clinical solutions continue to shift and evolve. Having a clear idea of any issues facing your pharmacy program and how to address them is key to optimizing your program.
There are a myriad of plans and considerations to continue to improve your PBM program. Be proactive and create action plans with your team and partners to address them. The extra attention can yield huge results. Your program and your injured workers deserve it.
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.
Mitchell is a WorkCompWire ad partner.
This is not a paid placement.