Wed vs progressive

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

2014

Progressive Medical, Inc. -‐ Copyright 2014 -‐ All Rights Reserved

Presenters

Brian Allen, Vice President, Government Affairs

Tron Emptage, R.Ph., M.A., Chief Clinical Officer

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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

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POLICY INFLUENCE ON PHARMACY BENEFITS


Physician Dispensing

•  Cost

–  Repackaged Medica#ons

–  Loss of Managed Care Benefits •  Outcomes

–  California Study –  WCRI Study

•  Scope of Prac#ce Debates

•  Poli#cs

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Compounded Medica#ons

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Policy Considera#ons

Media A^en#on

Efficacy

Controls


Opioid Controls and Monitoring Prescribers

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Poli#cs of Controlling Prescribing

Closed Formularies

Media A^en#on

PDMP Impact


Marijuana

Recrea7onal

•  Washington

•  Colorado

Medicinal

•  Utah

What is the impact on Workers’ Compensation?

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POLITICAL INFLUENCES IN 2014


Poli#cal Influences in 2014

Elec#on Year

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ACA Implementa#on

Tepid Economy

Workers’ Compensa#on Rate Pressures

CLINICAL INFLUENCE IN 2014


Aging Popula#on

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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


Obesity in the United States

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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


Opioid U#liza#on Declines for Second Year

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Source: IMS Health Journal Sen#nel


Why the Decrease in Opioid Analgesics?

Federal and State Guidelines

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Abuse Deterrent Formula#ons

REMS Programs

Urine Drug Monitoring

PDMPs


Opioid Monitoring Tools

Urine Drug Tes#ng State and Na#onal Drug Monitoring Databases

Pill Counts

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Medica#on Agreements

•  Statement of Mutual Responsibility

•  Explana#on of Medica#on Use •  Posi#ve Roadmap for Safety

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U#liza#on is Key

Age Obesity Medica#on Therapy

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PRODUCT INFLUENCE


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%

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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%


Generic Efficiency

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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


Compound Medica#on U#liza#on

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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


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

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FUTURE INFLUENCES


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.

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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


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

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TOTAL PROGRAM INFLUENCE


Early capture of prescrip7ons leads to greater control through connected programs.

Total Program Influence

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Quicker access to informa7on be^er equips claims professionals and clinicians to make decisions.

Early capture of prescrip#ons


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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.


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Analyze Risk

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Predic#ve power of variables change over #me

Percent of Significance (aggregated across multiple variables)


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


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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

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Progressive Medical, Inc. -‐ Copyright 2014 -‐ All Rights Reserved 37

A total program solu7on consis#ng of comprehensive data, risk analysis and clinical tools will greatly decrease the likelihood of a long-‐term claim

THE ART OF COMPROMISE


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.

Florida Senator Alan Hays discusses the art of compromise.

THANK YOU Ques#ons?


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

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Wed vs progressive

Health & Medicine

Transcript of Wed vs progressive