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By DAN REYNOLDS, managing editor of Risk & Insurance®

An intense national focus on the epidemic abuse of prescription pharmaceuticals has resulted in a wave of safety-oriented opioid products hitting the market, according to a recent study.

Andrews, who co-authored Healthcare Solutions' 2012 Workers' Compensation Drug Trends Report, said it remains to be seen whether these new products will lower utilization.

"I think the rationale is that the utilization will go down and the cost per unit will go up," Andrews said.

There were five new branded opioid pharmaceutical products introduced into the market in 2011, according to the report. Those included Butrans, a topical patch designed to address moderate to severe chronic pain, Abstral, a tablet designed to address breakthrough pain in cancer patients and ConZip, an extended release tablet engineered to address moderate to moderately severe chronic pain.

Andrews said what is striking about this new wave of opioid products, in addition to their purported emphasis on safety, is the sheer number of them.

On average, Andrews said, one might see one to two branded opioid products brought into the market on an annual basis. The high number of five in 2011 stems from the dynamic that manufacturers, stung by the negative attention opioid use and abuse is getting nationally, are working with the FDA to develop drugs that can address the pain control needs of patients while maintaining the integrity of manufacturers' brands by preventing misuse.

In the case of Abstral and a new branded intranasal spray, Lazanda (which are indicated for breakthrough pain in cancer patients) Andrews said the FDA put into effect in March Risk Evaluation and Mitigation Strategies or REMS, requiring prescribers and pharmacists dispensing these products to submit to more stringent registration requirements.

Prompting this trend is the abuse numbers of more mature painkilling products like OxyContin and Opana, which have alarmed many and have sparked a number of industry trends designed to provide value and control costs.

Abusers have historically crushed OxyContin and snorted it, or diluted it with water and injected it. New opioid products are being developed in which the pill loses its potency if crushed.

The use of predictive analytics, which has proven successful in controlling costs for personal lines healthcare carriers, is also finding traction with workers' compensation carriers who have been beset by ever rising average medical costs per lost time claims, with pharmacy use viewed as one of the chief culprits.

Employer drug testing, specifically the use of urinalysis, is also increasingly being used as a tool to control pharmaceutical drug misuse. According to a recent report by the California Workers' Compensation Institute, companies in California spent $100 million on drug testing in 2011.

The Healthcare Solutions report said that workers' compensation claims that are more than three years old, and which qualify as "mature" claims, continued to see a year-over-year increase in pharmacy utilization. In 2011, according to the report, average pharmacy utilization days for mature claims increased by 2.2 percent to 722 days. The company said it was seeing a similar trend within the class of claims in which opioids were used.

In his report, "State of the Line", Dennis Mealy, the chief actuary of NCCI Holdings Inc., details medical cost-per-claim increases that remain on the march upward nationally. Projected medical cost per lost-time workers' compensation claim was projected by Mealy to strike $28,000 in 2011, a 4 percent increase over the previous year.

May 29, 2012

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