This document summarizes trends shaping workers' compensation medication policies in 2014. It discusses the influence of various factors, including political influences from the Affordable Care Act and state elections; clinical influences like an aging population and the opioid epidemic; and product influences as new medications enter the market. It also outlines debates around issues like physician dispensing, compounded medications, medical marijuana, and opioid monitoring programs.

1. MEDICATION
TRENDS
SHAPING
WORKERS’
COMPENSATION
Na#onal
RX
Abuse
Summit
2014
2014

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Presenters
Brian
Allen,
Vice
President,
Government
Affairs
Tron
Emptage,
R.Ph.,
M.A.,
Chief
Clinical
Officer
2

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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

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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

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Compounded
Medica#ons
6
Policy
Considera#ons
Media
A^en#on
Efficacy
Controls

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Opioid
Controls
and
Monitoring
Prescribers
7
Poli#cs
of
Controlling
Prescribing
Closed
Formularies
Media
A^en#on
PDMP
Impact

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Marijuana
Recrea7onal
• Washington
• Colorado
Medicinal
• Utah
What is the impact on Workers’ Compensation?
8

9. POLITICAL
INFLUENCES
IN
2014

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Poli#cal
Influences
in
2014
Elec#on
Year
10
ACA
Implementa#on
Tepid
Economy
Workers’
Compensa#on
Rate
Pressures

11. CLINICAL
INFLUENCE
IN
2014

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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

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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

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Opioid
U#liza#on
Declines
for
Second
Year
14
Source:
IMS
Health
Journal
Sen#nel

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Why
the
Decrease
in
Opioid
Analgesics?
Federal
and
State
Guidelines
15
Abuse
Deterrent
Formula#ons
REMS
Programs
Urine
Drug
Monitoring
PDMPs

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Opioid
Monitoring
Tools
Urine
Drug
Tes#ng
State
and
Na#onal
Drug
Monitoring
Databases
Pill
Counts
16

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Medica#on
Agreements
• Statement
of
Mutual
Responsibility
• Explana#on
of
Medica#on
Use
• Posi#ve
Roadmap
for
Safety
17

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U#liza#on
is
Key
Age
Obesity
Medica#on
Therapy
18

19. PRODUCT
INFLUENCE

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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%

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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

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1.0%
INCREASE
IN
GENERIC
UTILIZATION
EQUATES
TO
1.8%
REDUCTION
IN
SPEND

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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

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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

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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

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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
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Medical
Marijuana
is
legal
in
20
states
• Medical
Marijuana
is
legal
in
20
states

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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

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Early
capture
of
prescrip7ons
leads
to
greater
control
through
connected
programs.
Total
Program
Influence
31

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Quicker
access
to
informa7on
be^er
equips
claims
professionals
and
clinicians
to
make
decisions.
Early
capture
of
prescrip#ons
Total
Program
Influence
32

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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

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Analyze
Risk
34
Predic#ve
power
of
variables
change
over
#me
Percent of Significance (aggregated across multiple variables)

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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

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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

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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

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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?

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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