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Progressive Medical: Medication Trends Shaping Workers' Compensation

Progressive Medical: Medication Trends Shaping Workers' Compensation

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  • 1. MEDICATION  TRENDS  SHAPING   WORKERS’  COMPENSATION   Na#onal  RX  Abuse  Summit  2014     2014  
  • 2. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Presenters   Brian  Allen,  Vice  President,  Government  Affairs   Tron  Emptage,  R.Ph.,  M.A.,  Chief  Clinical  Officer   2  
  • 3. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Discussion  Points   Policy  Influence  on  Pharmacy  Benefits   Poli#cal  Influence   Clinical  Influence   Product  Influence   Future  Influence   The  Art  of  Compromise   Q&A   3  
  • 4. POLICY  INFLUENCE  ON  PHARMACY  BENEFITS  
  • 5. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Physician  Dispensing   •  Cost   –  Repackaged  Medica#ons   –  Loss  of  Managed  Care  Benefits   •  Outcomes   –  California  Study   –  WCRI  Study   •  Scope  of  Prac#ce  Debates   •  Poli#cs   5   Insert icon
  • 6. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Compounded  Medica#ons   6   Policy  Considera#ons   Media  A^en#on   Efficacy   Controls  
  • 7. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Opioid  Controls  and  Monitoring  Prescribers   7   Poli#cs  of     Controlling  Prescribing   Closed  Formularies   Media  A^en#on   PDMP  Impact  
  • 8. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Marijuana   Recrea7onal   •  Washington   •  Colorado   Medicinal   •  Utah   What is the impact on Workers’ Compensation? 8  
  • 9. POLITICAL  INFLUENCES  IN  2014  
  • 10. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Poli#cal  Influences  in  2014   Elec#on  Year   10   ACA  Implementa#on     Tepid  Economy   Workers’  Compensa#on   Rate  Pressures  
  • 11. CLINICAL  INFLUENCE  IN  2014  
  • 12. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Aging  Popula#on   12   0   10,000,000   20,000,000   30,000,000   40,000,000   50,000,000   60,000,000   70,000,000   80,000,000   90,000,000   100,000,000   1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000   2010   2020   2030   2040   2050   Popula7on  65+  by  Age:  1900-­‐2050   Source:  U.S.  Bureau  of  the  Census   Age   65-­‐74    Age   75-­‐84    Age   85+   Source:    www.aoa.gov,  Projected  Future  Growth  of  the  Older  Popula#on  
  • 13. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Obesity  in  the  United  States   13   SOURCES:  CDC/NCHS,  Na#onal  Health  Examina#on  Survey  I  1960–1962;  Na#onal  Health  and  Nutri#on  Examina#on  Survey  (NHANES)  I  1971–1974;  NHANES  II  1976–1980;  NHANES  III  1988– 1994;  NHANES  1999–2000,  2001–2002,  2003–2004,  2005–2006,  2007–2008,  and  2009–2010.  Accessed  via  www.cdc.gov  January  2014.   Trends  in   overweight,  obesity,   and  extreme  obesity   among  men  aged   20–74  years:  United   States,  1960–1962   through  2009–2010  
  • 14. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Opioid  U#liza#on  Declines  for  Second  Year   14   Source:    IMS  Health  Journal  Sen#nel  
  • 15. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Why  the  Decrease  in  Opioid  Analgesics?   Federal  and     State  Guidelines   15   Abuse  Deterrent   Formula#ons   REMS  Programs   Urine  Drug     Monitoring   PDMPs  
  • 16. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Opioid  Monitoring  Tools   Urine  Drug  Tes#ng   State  and  Na#onal  Drug    Monitoring  Databases   Pill  Counts   16  
  • 17. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Medica#on  Agreements   •  Statement  of  Mutual   Responsibility   •  Explana#on  of  Medica#on  Use   •  Posi#ve  Roadmap  for  Safety   17  
  • 18. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   U#liza#on  is  Key   Age   Obesity   Medica#on  Therapy   18  
  • 19. PRODUCT  INFLUENCE  
  • 20. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Product  Claim  Medica#on  Trends   2013   RANK   MEDICATION     NAME   PERCENTAGE  OF   TOTAL  SPEND   1   ANALGESICS-­‐NARCOTICS   31.0%   2   ANTICONVULSANT   11.7%   3   ANTI-­‐RHEUMATIC   9.5%   4   ANTIDEPRESSANTS   8.4  %   5   DERMATOLOGICAL   8.2%   6   SKELETAL  MUSCLE  RELAXANTS   6.2%   7   ULCER  DRUGS   3.0%   8   HYPNOTICS   2.8%   9   ANTIASTHMATIC   2.3%   10   ANTIPSYCHOTICS   2.3%   20   Top  10  Therapeu7c  Classes   2013   RANK   MEDICATION     NAME   PERCENTAGE  OF   TOTAL  SPEND   1   OXYCONTIN  TABLET   7.6%   2   LIDODERM  PATCH   5.3%   3   CYMBALTA  CAPSULE   5.1%   4   LYRICA  CAPSULE   5.1%   5   CELEBREX  CAPSULE   4.0  %   6   NEURONTIN   3.9%   7   NORCO  T  TABLET   3.8%   8   PERCOCET  TABLET   3.4%   9   DURAGESIC  PATCH   2.7%   10   OPANA  ER  TABLET   1.7%   Top  10  Medica7ons *All  other  classes  combined  represent  10.71%    
  • 21. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Generic  Efficiency   21   Percentage  of  7mes  a  generic  was  dispensed  versus  the   number  of  opportuni7es  for  generic  dispense   Generic  efficiency  is  more  meaningful  than  generic  fill  rate  as  it  is  not  swayed  by  an   introduc#on  or  removal  of  generic  medica#on  from  the  market.   Recent  or  Upcoming  Generic  Releases:   • LidoDerm  5%  Patches   • Aciphex   • Cymbalta   • Exalgo   • Lunesta   • Nexium   • Zyvox   • Celebrex  
  • 22. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   22   1.0%  INCREASE  IN  GENERIC   UTILIZATION  EQUATES  TO     1.8%  REDUCTION  IN  SPEND      
  • 23. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Compound  Medica#on  U#liza#on   23   2012   0.53%   of  all  prescrip#on   medica#ons   3.81%     of  total     drug  spend     2013   0.60%   of  all  prescrip#on   medica#ons   2.08%     of  total     drug  spend    
  • 24. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Common  Topical  Ingredients     On  average,  there  are  four  to  five  individual  ingredients  in  compounded  medica#ons.   Therapeu7c  Classes   Commonly  used  agents   NSAIDs   Ibuprofen,  Diclofenac,  Ketoprofen,  Flurbiprofen   Opioids   Tramadol   Local  anesthe#cs   Lidocaine,  Benzocaine,  Ketamine   An#depressants   Amitriptyline,  Nortriptyline   An#convulsants   Gabapen#n,  Lyrica   Skeletal  muscle  relaxants   Cyclobenzaprine,  Baclofen   Other  topical  analgesics   Capsaicin,  Menthol,  Methyl  Salicylate,  Clonidine   24  
  • 25. 25   FUTURE  INFLUENCES  
  • 26. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Zohydro™  ER   •  Zohydro  ER  is  indicated  for  the  management  of  pain  severe  enough  to  require   daily,  around-­‐the-­‐clock,  long-­‐term  opioid  treatment  and  for  which  alterna#ve   treatment  op#ons  are  inadequate.       •  Approved  by  the  Food  and  Drug  Administra#on  (FDA),  it  is  the  first  extended-­‐ release  hydrocodone  only  pain  reliever  available  in  the  United  States.   •  Schedule  II  substance;  a  new  prescrip#on  is  required  for  every  fill.   •  Its  formula#on  does  not  include  abuse-­‐deterrent  proper#es  and  risk  poten#al  has   sparked  public  outcry  and  vigorous  debate.   •  Our  posi#on  is  that  the  risks  associated  with  this  new  medica#on  likely  outweigh   the  benefit  and  we  are  strongly  recommending  that  our  customers  either  exclude   this  medica#on  from  their  customized  Medica#on  Plans/Formularies  or  at  a   minimum  require  Prior  Authoriza#on  as  is  consistent  with  our  standard  approach.   26  
  • 27. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Medical  Marijuana   Legaliza#on  among  mul#ple  states  is  genera#ng  conversa#on   •  Employer  challenges  include   –  A  heightened  level  of  concern  when  an  injured  worker  returns  to  a  safety-­‐ sensi#ve  occupa#on,  such  as  driving  or  construc#on,  while  subject  to  the   poten#al  adverse  cogni#ve  and  psychological  effects  of  marijuana.     –  Quan#fica#on  of  the  amount  of  marijuana  consumed  by  the  injured  worker  is   not  available  through  urine  drug  tes#ng,  thereby  limi#ng  the  ability  to   determine  if  he  or  she  has  consumed  the  prescribed  dose,  or  is  in  fact  acutely   intoxicated.       –  Understanding  the  poten#al  impact  to  Drug  Free  Workplace  policies  as  well  as   other  safety  and  risk  management  protocols  and  programs   •  Based  on  the  best  available  scien#fic  evidence  and  recommenda#ons  at  this  #me,   its  classifica#on  as  a  Class  I  substance  and  the  lack  of  an  assigned  NDC,  medical   marijuana  remains  excluded  from  our  Medica#on  Plans/formularies   27  
  • 28. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Medical  Marijuana  is  legal  in  20  states   •  Medical  Marijuana  is  legal  in  20  states  
  • 29. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Interdisciplinary  Rehabilita#on  Programs   “The  gold  standard  of  treatment  for   individuals  with  chronic  pain  who  have   not  responded  to  less  intensive  modes   of  treatment.”   –  USDHHS  (Na#onal  Guideline  Clearinghouse)     • Collabora#ve  Processes     • Evidence-­‐based  Medicine   • Ongoing  Communica#on   • Concurrent  Execu#on   • Shared  Problem  Solving   29  
  • 30. TOTAL  PROGRAM  INFLUENCE  
  • 31. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Early  capture  of  prescrip7ons  leads  to  greater   control  through  connected  programs.   Total  Program  Influence   31  
  • 32. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Quicker  access  to  informa7on  be^er  equips   claims  professionals  and  clinicians  to  make   decisions.   Early  capture  of  prescrip#ons     Total  Program  Influence   32  
  • 33. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Quicker  access  to  informa#on   Early  capture  of  prescrip#ons     Mul7-­‐factor  risk  analysis  based  on  pharmacy   behavior,  the  injury  and  overall  demographics   should  be  applied  to  be^er  predict  the  path     of  a  claim.   Total  Program  Influence   33  
  • 34. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Analyze  Risk     34   Predic#ve  power  of  variables  change  over  #me   Percent of Significance (aggregated across multiple variables)
  • 35. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   There  will  always  be  claims  that  mature  into   complicated  situa7ons.   Clinical  Tools   • Claims  Professional  Outreach   • Physician  Outreach   • U#liza#on  Reviews   • Interven#on  Reports   • Peer-­‐to-­‐Peer  Review   Total  Program  Influence   35  
  • 36. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Key  Outcomes   •  1.7%  reduc7on  in  overall  prescrip7on  cost  per  claim   Opioid  Analgesics   •  7.2%  reduc#on  in  overall  narco#c  spend       •  5.5%  reduc#on  in  overall  days  supply     •  5.6%  fewer  overall  scripts   •  10.6%  reduc#on  in  overall  MED   36  
  • 37. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   37   A  total  program  solu7on   consis#ng  of  comprehensive  data,   risk  analysis  and  clinical  tools  will   greatly  decrease  the  likelihood  of  a   long-­‐term  claim      
  • 38. THE  ART  OF  COMPROMISE  
  • 39. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Compromise  is  a  way   of  life  and  occurs  in  nearly   every  interac#on,  both  in  our   personal  and  professional   lives.  We  do  it  every   day.     As  Florida  Senator  Alan  Hays   a^ests,  when  both  sides  are   willing  to  give  a  li^le  bit,  the   result  will  likely  be  an  even   beaer  solu7on.  
  • 40. Florida  Senator  Alan  Hays  discusses  the  art  of  compromise.  
  • 41. THANK  YOU   Ques#ons?    
  • 42. Progressive  Medical,  Inc.    -­‐    Copyright  2014  -­‐  All  Rights  Reserved   Contact  Us   Brian  Allen,  Vice  President,  Government  Affairs   Brian.Allen@progressive-­‐medical.com   Tron  Emptage,  R.Ph.,  M.A.,  Chief  Clinical  Officer   Tron.Emptage@progressive-­‐medical.com   42