This much we know: Rising prescription-drug costs in workers' compensation cases have become alarming. The prescription-drug share of total medical costs by accident year increased from 6.5 percent in 1997 to 9.6 percent in 2001, according to the National Council on Compensation Insurance. Today, 10 cents of every dollar spent on medical care for workers' compensation is spent on prescription drugs.
Why the increase? The reasons vary. Whatever the reason, it is absolutely critical to determine whether the prescribed drug is treating a work-related injury or whether it is treating another ailment unrelated to the injury.
Knowing what questions to ask and where to go for more information will keep prescription-medication costs under control.
One reason for higher prescription-drug costs is an aging workforce. The average age of the U.S. population today is in the 40s and is slowly moving upward. By 2030, 20 percent of the population will be 65 years of age or older. A 2003 survey by AARP noted that 80 percent of baby boomers planned on working past retirement age.
An aging population often means more prescription drugs to treat injuries. A study conducted by the National Academy of Social Insurance found that although older workers are less prone to injuries resulting from traumatic events, they are more prone to impairments associated with aging, including repetitive motion injuries and back pain. Therefore, it is important to distinguish between medications to treat a work-related injury with medications that treat ailments associated with aging, like arthritis, high blood pressure and gastrointestinal problems.
Another reason for higher prescription-drug costs is direct-to-consumer advertising. It's no secret that pharmaceutical companies increase advertising efforts on certain drugs to build awareness. Once patients are aware of a drug, they will ask their doctors for a prescription. Unfortunately, some pharmaceutical companies spend more money on advertising than on research and development.
Prescribing habits also influence the rising cost of medications. While the majority of physicians prescribe medications appropriately, there are some who will write a prescription for whatever a patient requests. These patients subscribe to the "pill for every ill" mentality, even when the illness is viral and won't respond to an antibiotic.
THE "GRAY AREA" OF MEDICATIONS
A "gray area" medication is one that could treat a work-related injury or could treat an unrelated condition. And here, we tread on less solid ground.
Antibiotics. Some of the most common antibiotics used in workers' comp cases include penicillins, cephalosporins and quinolones. These are often the first line of defense in combating bacterial infections. They are also the first line of defense to treat bronchial and ear infections, as well as strep throat. These medications may be entirely appropriate for work-related skin lacerations, but should be questioned for sprain or strains. Or they may not. Be sure to ask these questions: What is the injury description and diagnosis? Did the patient have a procedure or surgery requiring an antibiotic?
Anti-inflammatory pain medications. Many work-related injuries require pain medication. If the injury is a knee strain, anti-inflammatory pain medication is entirely appropriate. However, if the injury was a laceration from several years ago, be sure to ask why medication is needed now to treat pain and inflammation.
Narcotic pain medications. Narcotics are often part of therapy for many work-related injuries. However, the choice of medication and length of use may not be appropriate. Narcotic pain medications can be short-acting for chronic pain, such as Vicodin, Lortab, Percocet or OxyIR. Or, they can be long-acting for acute pain, like OxyContin, MS Contin, Duragesic or Avinza. It may be helpful to consult with the patient's physician to understand the reason for the narcotic and length of use.
Topical pain medications. When treating neuropathic pain, physicians will often prescribe topical anesthetics such as Lidoderm patches for shingles or compound medications for pain management. Topical pain medications are applied to the origin of pain and cause the nerves to numb, which decreases the electrical transmission of pain sensation by the body. It's important to remember that topical medications should be periodically reviewed by a patient's physician to ensure efficacy.
Hypnotics. Insomnia is often associated with both acute and chronic pain disorders. Often, physicians will prescribe a hypnotic, such as Restoril, Halcion, Ambien or Sonata for short-term use, usually two to three weeks. Questions to ask regarding ongoing use of hypnotics include: What is the treatment plan? How long has the patient been on this medication? Are the refills sporadic or consistent? Has there been any sleep-behavior intervention?
Anticonvulsants. The use of anticonvulsants as treatment for workers' comp injuries has increased during the past few years. This is partially because anticonvulsants are now known to treat neuropathic pain disorders as well. Because of this emerging use, it is important to determine the physician's reason for selecting an anticonvulsant and how it will be used to treat the approved injury. Questions to ask include: How is this medication related to the compensable injury? Is the medication effective?
Antidepressants. Controversy over the increasing use of antidepressants during workers' comp treatment, especially with chronic pain disorders, continues to be a major issue for claim adjusters. Patients with chronic pain suffer dramatic reductions in physical, psychological and social well-being. Their quality of life often decreases; therefore, depression can be a measurable aspect of chronic pain.
Ulcer medications. Many medications used to treat workers' comp injuries can cause an upset stomach. In determining the appropriateness of therapy that includes ulcer medications, ask these questions: What is the diagnosis? Does the patient have a history of gastrointestinal problems? What has the patient tried in the past to treat gastrointestinal problems? What current medications could be causing the disorder? Is this something that existed before the injury?
Miscellaneous medications. Many other medications may also be considered "gray area" medications. They include cardiovascular, antipsychotic and allergy medications.
Cardiovascular medications can be used to prevent headaches from a severe brain injury, treat pain-induced hypertension and in some cases treat chronic regional pain syndrome. However, these medications are also used to treat hypertension in the aging population.
Cardiovascular medications also treat heart attack and stroke patients, but the situation becomes less clear when the aging patient with a family history of cardiovascular problems suddenly presents prescriptions for these medications. Again, it is important to know the nature of the injury and how the prescribed medication will treat it.
Antipsychotic medications, like Zyprexa and Risperdal, are approved to treat schizophrenia and bipolar-associated mania; however, they are also being studied to treat post-traumatic stress disorder, treatment-resistant depression and depression associated with anxiety.
Antihistamines are often used to treat dermatological disorders associated with exposure to chemicals or toxic substances. They are also used to treat seasonal and perennial allergy symptoms. Therefore, it is important to know the nature of injury and how the medication specifically relates to it.
TRON EMPTAGE is vice president of pharmacy benefits with Progressive Medical Inc., an Ohio-based provider of workers' compensation services.
February 1, 2006
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