Presentation is loading. Please wait.

Presentation is loading. Please wait.

2014 APRIL 2013 June 10, 2014. 2 2014 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright 2014 - All Rights Reserved.

Similar presentations


Presentation on theme: "2014 APRIL 2013 June 10, 2014. 2 2014 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright 2014 - All Rights Reserved."— Presentation transcript:

1 2014 APRIL 2013 June 10, 2014

2 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Administrative Items Submit your questions via the webinar chat box or Webinar recording will be available online at shortly after the live session No continuing education credits are available with this webinar

3 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Matthew Foster, PharmD Clinical Pharmacy Manager Brian Allen, CIC Vice President of Governmental Affairs Joe Anderson, MBA Director of Analytical Services Tron Emptage, M.A., R.Ph. Chief Clinical Officer Presenters

4 2012 – 2013 Combines data from Progressive Medical and PMSI into a single data set and was analyzed as one unit Over 300,000 claims and nearly six million prescriptions were analyzed Does not include transactions for clients with us fewer than two years Methodology

5 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Average Wholesale Price Strong network enforcement programs Advanced analytics Holistic utilization management Collaborative clinical interactions 7.8% Average Cost per Days’ Supply 6.3% Product and Claim Mix 3.2% Average Prescription Cost per Claim 1.7% Overall Cost and Utilization Trends

6 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved The top 10 classes represent 85% of the overall spend Overall spend of long-term opioid analgesics decreased 7.2% Generic utilization rate of 76% Therapeutic Classes

7 COST MANAGEMENT

8 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Average Wholesale Price (AWP) Inflation The upward trend continues Both brand and generic medications affected

9 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Average Wholesale Price (AWP) Inflation 20% Celebrex ® Cymbalta ® Lyrica ® More than 20% Percocet ® Exalgo ® Fentora ® Amrix ® 6% 6% hydrocodone/APAP 7% 7% metaxalone BrandGeneric

10 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved For every 10% shift in days’ supply from retail to mail order, our clients experienced a 1.2% reduction in spend Average days’ supply for mail order is 53.5 days compared to 24.6 days for retail The average cost per days’ supply of mail order prescriptions was 17.3% less than its retail equivalent Mail Order Effective mail order programs favorably impact cost containment

11 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Compounded Medications 0.62% We typically see topical formulations On average, compounded medications include 4-5 ingredients Represented 0.69% of total number of prescriptions, up slightly from 0.62%

12 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Used to treat complex medical conditions including rheumatoid arthritis, Hepatitis C, HIV and some cancers Encountered in workers’ compensation claims for occupations such as emergency responders and health care professionals Specialty medications did not represent significance to our book of business from the standpoint of either cost or utilization Specialty Medications

13 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Network discounts are applied to more prescriptions for greater cost savings Formulary controls, utilization edits and business rules are consistently applied Collection, eligibility and verification calls are virtually eliminated; paper bills virtually cease More data is captured allowing payers to proactively manage their claims Payers are better equipped to spot the warning signs of misuse and abuse, which triggers an intervention earlier in the claim Therapeutic concerns are identified sooner allowing for more informed and empowered medication management Network Enforcement A key to successful cost containment is a PBM’s ability to drive transactions “in network”

14 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved 98% Through our efforts we achieve retail network penetration rates up to

15 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Spend related to physician-dispensed medications decreased 14% Cost of physician dispensed medication was flat Top six states California, Florida, Illinois, Louisiana, Maryland and Pennsylvania Network Enforcement Our specialty network continues to expand to help optimize cost control

16 UTILIZATION MANAGEMENT

17 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Claim Age 0.62% We realized a decrease in both utilization and prescription cost per claim in all claims, even with a slight increase in claims aged ten years or older

18 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Opioid Analgesics 0.62% Our efforts, in collaboration with our clients and industry stakeholders is starting to bend the curve Metrics associated with utilization and cost are all trending downward

19 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Our programs are driven by evidence-based medicine, national and regional approved guidelines and experienced clinicians Collaborative approach involving education, effective screening and careful monitoring American College of Occupational and Environmental Medicine (ACOEM) released an updated treatment guidelines limiting MED doses to 50 mg per day Morphine Equivalent Dose (MED)

20 Generic Utilization and Generic Efficiency Generic utilization went up 1.9 points in 2013, moving from 74.1% to 76.0%

21 ANALYTICS, INTERVENTIONS, AND CLINICAL INTERACTIONS

22 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved 0.62% Multi-variate, log-linear regression models predict pharmacy costs Data includes age, geography, prescriber, medications filled, and local demographics to identify high-cost claims Predictions allow for smarter clinical triage and drive better decision-making Protects clients’ financial interests Optimizes therapy Analytics Predictive analytics combines our expertise with industry and claim data to identify which claims will result in long-term pharmacy costs

23 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Early InterventionLong-term Intervention TimingBegins after 120 daysBegins after 180 days Goal Find the 10% of claims that make up 90% of long-term pharmacy costs. Target changes in behavior to any chronic issues that have started to develop Outcome Our models identify 67% of the claims that will be long-term pharmacy cost claims 62% success rate in eliciting a change to an injured worker’s therapeutic regimen Interventions – A Couple Examples of our Program in Practice Our models accurately identify the claims that require attention

24 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved 0.62% Our highly-trained team of clinicians is well versed in workers’ compensation and medication therapy management Multiple Prescriber ServiceUrine Drug Testing and Monitoring Designed to Identify injured workers receiving medications from multiple prescribers Help payers and physicians confirm the injured worker is adhering to their medication therapy regimen Results 94% conversion to a single prescriber 9.6% decrease in total spend for the study group 32% decrease in utilization of opioid analgesics 26% reduction in total utilization of all medications Clinical Interactions – A Couple Examples of our Program in Practice

25 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved 0.62% Shorter claim duration means fewer claims use prescription medications years after the injury Claim Duration of Pharmacy Use Fewer active claims may influence: Loss ratios Combined operating ratios Adjustor case loads Claim closure ratios Productivity Experience modifications Premium reductions

26 INDUSTRY INFLUENCES

27 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Typical Characteristics Body functions begin to decrease as early as the third decade of life Higher incidence of pain Prolonged recovery More prevalent psychiatric factors What to Manage and Monitor Drug-to-drug interactions Intensified side effects Comorbid conditions Use of certain antidepressants as an adjunctive medication Aging Population

28 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Comorbid Conditions The presence of a comorbid condition may extend the duration of treatment of the primary injury or become a compensable condition Depression Insomnia Obesity

29 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Prescribing Practices There are an increasing number of prescriptions for opioid analgesics being written by nurse practitioners and physician assistants

30 GOVERNMENT AFFAIRS

31 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Texas closed formulary became fully operational for all claims and has achieved significant results by reducing “N” drugs by over 70% and trimming reimbursement for these drugs by over 80% Oklahoma adopted a closed formulary that took effect February 1, 2014 Louisiana and California are looking at adopting a closed formulary Closed Formularies

32 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Oklahoma enacted guidelines requiring pre-authorization for all compounded medications as part of their closed formulary Mississippi adopted a rule addressing how compounded medications can be billed and when they should be pre-authorized Compounded Medications The FDA has called for stricter controls and many states are questioning the efficacy and cost of compounded medications

33 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Hydrocodone products most commonly addressed Rescheduling impacts an injured worker’s ability to obtain a refill States with activity –West Virginia passed legislation to move hydrocodone products to Schedule II –Louisiana just passed SB 618 –Consideration also at the Federal level Medication Rescheduling The rescheduling of certain medications is a growing trend

34 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved The Ohio Bureau of Workers’ Compensation adopted standard dose weaning schedules for opiates and a set of benzodiazepines Arizona passed legislation requiring pre-authorization, a medication agreement and random drug testing for all Schedule II medications Florida and Alaska introduced legislation that requires drug testing West Virginia introduced legislation to ban non-abuse-deterrent hydrocodone products Virginia and New Jersey imposed stricter requirements to verify a patient’s drug use history prior to prescribing or dispensing opioid Delaware enacted legislation to control the number and the cost of drug tests Opioid Analgesics Finding an effective way to curb the misuse and abuse of opioids continues to be a key focus for stakeholders throughout the system

35 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved New legislation could undermine the positive results that managed pharmacy care has delivered to the various states’ workers’ compensation systems Alabama, Arizona, Iowa, Maryland, Mississippi, Missouri, New York, and West Virginia have introduced legislation on this issue Pharmacy Choice One of the best tools for controlling pharmacy costs is the use of a managed care network

36 Physician Dispensing and Repackaged Medications A challenge throughout the country Inroads are being made –Florida –Delaware –Indiana –Hawaii –Pennsylvania –Utah

37 Prescription Drug Monitoring Programs States are re-tooling or otherwise enhancing their programs –Enforcement –Educational efforts –Availability beyond state borders Activities also occurring at the Federal level We anticipate this will continue

38 Medical Marijuana Legalization in growing number of states is generating conversation Schedule I classification at the Federal level Does not have an assigned NDC, so may not be adjudicated Excluded from our medication plans and formularies

39 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved Through product innovation and service enhancements we will work with our clients to make our industry better, together We will use our balanced and unbiased perspective, veteran clinical expertise, keen analytic insight, and strong moral compass to guide us Looking Ahead In 2014 and beyond we do not foresee any of today's challenges going away; rather we will become even more adept at mitigating their influence

40 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright All Rights Reserved QUESTIONS? to

41 THANK YOU View or request a copy of the complete report:


Download ppt "2014 APRIL 2013 June 10, 2014. 2 2014 Workers’ Compensation Drug Trend Report l Progressive Medical, Inc. and PMSI - Copyright 2014 - All Rights Reserved."

Similar presentations


Ads by Google