6 Emerging Supply Chain Risks You Should Know
The Wolf of RIMS
RIMS just concluded in Denver, and I had a few observations.
It was cold, very cold. Given that the Spencer/Gallagher Golf Tournament is always a part of RIMS, why isn’t the conference held in cities with much better weather? Who could forget Chicago a few years ago, where the golf tournament lasted three holes because of the snow and those who chose Cubs opening day didn’t fare much better. I know we can never really guarantee the weather but we might want to increase the chances of a good climate for a great meeting. Eighteen holes of golf in the sun beats three holes in the cold any day.
And then there was the keynote speaker – Jordan Belfort, the author of “The Wolf of Wall Street.” I actually couldn’t believe RIMS would pick him to speak at our convention. Let’s see, his redeeming values were abusing drugs, denigrating women and maybe worst of all stealing money from at least 1,500 people. Nobody should have money stolen from them, but Belfort concentrated mostly on the weak and vulnerable, retirees or people just getting by. Nice guy, our motivational speaker.
So I was thinking, is this the best our industry could do for a keynote speaker? Was there a lesson RIMS wanted to teach, like “Greed is Bad”?
Of course, people deserve a second chance, so I did a little research after I learned Belfort was the keynote speaker. Nancy Dillon from the Daily News wrote, “according to Federal prosecutors, Belfort failed to live up to the restitution requirement of his 2003 sentencing agreement. The agreement requires him to pay 50 percent of his income towards the 1,500 clients he defrauded.” The Federal government filed a complaint since Belfort had an income of $1,767,203 in 2013 from his book/movie rights and another $24k from speaking engagements like the one at RIMS. Yet, According to Ben Child of the guardian.com he has only paid back $11.6 million of the $110.4 million he was ordered to pay as restitution.
For more details of just how rotten Belfort is, read this NY Times article by Joel M.Cohen who prosecuted the case.
So I was thinking, is this the best our industry could do for a keynote speaker? Was there a lesson RIMS wanted to teach, like “Greed is Bad”? Most of us saw Michael Douglas in Wall Street, some lived it. Couldn’t we as an industry have done better?
In the last year, I saw some great conference speakers such as Garrison Wynn, author of “The Real Truth About Success” as well as Lt. Col. Rob Waldman, a highly decorated fighter pilot, author and businessman and wonderful motivational speaker. And we got a guy who stole money from people and has yet to pay it back. Belfort would be a solid choice if we we motivating crooks, however I like to think a bit more highly of our community
Maybe Albert Einstein said it best when he said “the value of a man should be seen in what he gives and not in what he is able to receive.”
There are plenty of good, decent people who give back to society – why don’t we stick with them as our guest speakers!
Read all of Joe Boren’s Risk Insider contributions.
Compounding: Is it Coming of Age?
The WC managed care market has generally viewed the treatment method of Rx compounding through the lens of its negative impact to cost for treating chronic pain without examining fully the opportunity to utilize “best practice” prescription compounds to help combat the opioid epidemic this nation faces. IPS stands on the front lines of this opioid battle every day making a difference for its clients.
After a shaky start cost-wise, prescription drug compounding is turning the corner in managing chronic pain without the risk of opioid addiction. A push from forward-thinking states and workers’ compensation PBMs who have the networks and resources to manage it is helping, too.
Prescription drug compounding has been around for more than a decade, but after a rocky start (primarily in terms of cost), compounding is finally coming into its own as an effective chronic pain management strategy – and a worthy alternative for costly and dangerous opioids – in workers’ compensation.
According to Greg Todd, CEO and founder of Integrated Prescription Solutions Inc. (IPS), a Costa Mesa, Calif.-based pharmacy benefit manager (PBM) for the workers’ compensation and disability market, one reason compounding is beginning to hit its stride is because some states have enacted laws to manage it more effectively. Another is PBMs like IPS have stepped up and are now managing compound drugs in a much more proactive manner from an oversight perspective.
By definition, compounding is a practice through which a licensed pharmacist or physician (or, in the case of an outsourcing facility, a person under the supervision of a licensed pharmacist) combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.
During that decade, Todd explains, opioids have filled the chronic pain management needs gap, bringing with them an enormous amount of problems as the ensuing addiction epidemic sweeping the nation resulted in the proliferation and over-consumption of opioids – at a staggering cost to both the bottom line and society at large.
As an alternative, compounded topical cream formulations also offer strong chronic pain management but have limited side effects and require much reduced dosage amounts to achieve effective tissue level penetration. In fact, they have a very low systemic absorption rate.
Bottom line, compounding provides prescribers with an excellent alternative treatment modality for chronic pain patients, both early and late stage, Todd says.
Time for Compounding Consideration
That scenario sets up the perfect argument for compounding, because for one thing, doctors are seeking a new solution, with all the pressure and scrutiny they’re receiving when trying to solve people’s chronic pain problems using opioids.
Todd explains the best news about neuropathic pain treatment using compounded topical analgesic creams is the results are outstanding, both in terms of patient satisfaction in VAS pain reduction but also in reduction potentially dangerous side effects of opioids.
The main issue with some of the early topical creams created via compounding was their high costs. In the early years, compounding, which does not require FDA approval, had little oversight or controls in place. But in the past few years, the workers compensation industry began to take notice of the solid science. At the same time, medical providers also were seeing the same science and began writing more prescriptions for compounding – which also offers them a revenue stream.
This is where oversight and rigor on the part of a PBM can make a difference, Todd says.
“You don’t let that compounded drug get dispensed when you’re going to pay for it without having a chance to approve it,” Todd says.
Education is Critical
At the same time, there is the growing, and genuine, need to start educating the doctors, helping them understand how they can really deliver quality pain management to a patient without gouging the system. A good compounding specialty pharmacy network offering tight, strict rules is fundamental, Todd says. And that means one that really reaches out to work with the doctors that are writing the prescriptions. The idea is to ensure that the active ingredients being chosen aren’t the most expensive sub-components because that unnecessarily will drive the cost of overall compound “through the ceiling.”
IPS has been able to mitigate costs in the last couple years just by having good common sense approach and a lot of physician outreach. Working with DermaTran Health Solutions and its national network of compounding pharmacies, IPS has been successfully impacting the cost while not reducing the effectiveness of a compounded prescription.
In Colorado, which has cracked down on compounding profiteering, Legislative change demanded no compound could be more than $350.00 period. What is notable, in an 18-month window for one client in Colorado, IPS had 38 compound prescriptions come through the door and each had between 4 and 7 active ingredients. Through its physician education efforts, IPS brought all 38 prescriptions down 3 active ingredients or less. IPS also helped patients achieve therapeutic success (and with medical community acceptance). In that case, the cost of compound prescriptions was down to an average of $350, versus the industry average of $788. Nationwide IPS has reduced the average cost of a compound prescription to $478.00.
Todd says. “We’ve still got a way to go, but we’ve made amazing progress in just the past couple of years on the cost and effective use of compound prescriptions.”
For more information on how you can better manage your costs for compound prescriptions, please call IPS at 866-846-9279.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IPS. The editorial staff of Risk & Insurance had no role in its preparation.