By CYRIL TUOHY, managing editor of Risk & Insurance®
Alarmed at the amount of narcotics prescribed to treat workers? comp injures, the State Comp Insurance Fund of California is pursuing early intervention strategies to head off lifetime addictions to painkillers.
The strategy includes a requirement of drug utilization review approval for medications prescribed beyond 60 days, sending side effect warning letters to doctors and patients by pharmacy benefits managers, and physician-to-physician conversations, said Dr. Bernyce Peplowski, SCIF?s medical director.
In California, she said, the workers? comp system is skewed because it ?denies therapy but authorizes opioids.? That system needs to be turned on its head, she said, speaking at a session Wednesday on health and medical management during the 20th Annual National Workers? Compensation and Disability Conference® & Expo.
The misuse of Schedule II narcotics is among the most pressing challenges facing the workers? comp system and not a day goes by without a study about the increasing use of opioids to treat injured workers with chronic pain.
In April, for example, Peplowski said more than 10,000 prescriptions were written for narcotic drugs compared with only 1,500 prescriptions written for nonsteroidal anti-inflammatory drugs.
Controlling the prescribing of narcotics is seen as key to controlling workers? comp costs because so few people are responsible for such a high percentage of utilization, industry data reveal.
The top 1 percent of narcotic users consume 40 percent of all narcotics, and the top 10 percent of narcotic bills sent through the workers? comp system are responsible for 80 percent of the costs, said Barry Lipton, senior actuary with the National Council on Compensation Insurance Inc.
?Costs are coming from a small percentage of claimants,? he said, noting that the narcotic costs per claim was also going up. The top three prescription narcotics in terms of workers? comp spending were oxycontin, lidoderm and hydrocodone, he said.
Gary Mills, director of Pacifica Pain Management Services in Napa, Calif., said the industry is faced with a three-pronged assault. Patients want prescription drugs, doctors are willing to write scripts, and insurance companies are willing to reimburse for them, he said.
?It?s a serious cultural issue,? Mills said. ?We expect magic. We expect a pill, a chemical if not surgery, to cure it.?
?Prescription drugs are easier to buy than beer,? he also said. ?More than 70 percent of abusers are getting drugs from friends and family. In every medicine chest we have a Schedule II or Schedule III narcotic.?
Regulators are also keen to place restrictions on the prescribing of narcotics in workers? comp.
New York Attorney General Eric T. Schneidermann is hoping to enhance the state?s prescription drug monitoring program. His office has proposed that doctors and pharmacists be required to submit information and consult an online database before dispensing narcotics.
The use of oxycodone prescriptions rose 66 percent in New York City alone from 2007 to 2009, Schneidermann's office said.
November 10, 2011
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