Presentation is loading. Please wait.

Presentation is loading. Please wait.

National Council of Self-Insurers 2011 Annual Meeting Dennis M. Sponer, Esq., CEO ScripNet, Inc. www.scripnet.com.

Published byCameron Johnson Modified over 8 years ago

Similar presentations

Presentation on theme: "National Council of Self-Insurers 2011 Annual Meeting Dennis M. Sponer, Esq., CEO ScripNet, Inc. www.scripnet.com."— Presentation transcript:

1 National Council of Self-Insurers 2011 Annual Meeting Dennis M. Sponer, Esq., CEO ScripNet, Inc. www.scripnet.com

2 Overview Introduction Narcotics – Abuse – Diversion Solutions – State Solutions – Federal Solutions – Industry Solutions – Payer Solutions Conclusion

3 Narcotics – CWCI Study Top 10% of docs that prescribe C-2s in California account for 80% of all workers’ compensation prescriptions for these narcotic drugs Nearly HALF of the prescriptions were for minor back injury claims 20% of C-2 prescriptions are for Fentanyl – usually DURAGESIC® Patches Source: www.insurancejournal.com/news/west/2011/04/29/196666.htm Source: www.insurancejournal.com/news/west/2011/04/29/196666.htm

4 Narcotics – NCCI Study Narcotics’ share of medication expenses increases as claims age – from 15% in year 1 to as much as 35% in year 5 The Longer the I/W is on Narcotics – the Longer they are off WORK Increased likelihood of ADDICTION rehabilitation Source: “Narcotics in Workers Compensation,” NCCI Research Brief, December 2009

5 Injured Workers - Diversion Diversion is the use of prescription drugs for recreational purposes. The term comes from "diverting" of the drugs from their original purposes. Prescription drugs are second only to marijuana in illicit drug use.

6 Diversion – Scope of the Problem Drug diversion costs $72.5 billion a year. Individual plans each lose $8.6 million to $857 million a year. workers’ compensation insurers. Large diversion losses affect both traditional health insurers and workers’ compensation insurers. Source: Coalition Against Insurance Fraud Publication, Prescription for Peril, 2007

7 Diversion – Commonly Diverted Drugs Hydrocodone (Vicodin®, Lortab®, and Lorcet®) Oxycodone (OxyContin®) Fentanyl (Duragesic®) ACTIQ® Hydromorphone (Dilaudid®) Meperidine (Demerol®) Morphine (MS Contin®) Pentazocine (Talwin®) Dextropropoxyphene (Darvon®) Methadone (Dolophine®)

8 ACTIQ ® is used to treat breakthrough pain in adult patients with cancer (16 years and older) who are already taking other opioid pain medicines for their constant (around-the-clock) cancer pain.... 90% of ACTIQ ® prescriptions are off label. Diversion – Diversion – ACTIQ® Sources: http://www.actiq.com/patients/aboutbtcp/default.asp and http://www.primetherapeutics.com/pdf/Actiq.pdf

9 Diversion – Commonly Diverted Drugs Prescription tranquilizers and sedatives are also commonly abused. HyAlprazolam (Xanax®) Diazepam (Valium®) CODEINE Lorazepam (Ativan®) Pentobarbital (Nembutal®) Phenobarbital (Luminal®) Secobarbital (Seconal®) Zolpidem (Ambien®) Source: DEA Publication, National Prescription Drug Threat Assessment 2009

10 Diversion – What do Payers Pay? 800 mcg ACTIQ® 800 mcg AWP $82.68 80 mg OxyContin® 80 mg AWP $20.30 Fentanyl 75 mcg AWP $72.40 Prices are average for a 30 day supply.

11 Commonly Diverted Drugs – Street Prices DRUGSTATE / TERRITORYLOW $HIGH $QUANTITY /WEIGHT Diazepam Connecticut$2.00 10 milligrams DiazepamMaine $2.00 10 milligrams Diazepam Massachusetts$2.00 10 milligrams DiazepamNew Hampshire $2.00 10 milligrams DiazepamVermont$2.00 10 milligrams Valium® Connecticut $3.00 $5.0010 milligrams Valium® Maine $3.00 $5.0010 milligrams Valium® Massachusetts $3.00 $5.0010 milligrams Valium® New Hampshire $3.00 $5.0010 milligrams Valium® Vermont$3.00$5.0010 milligrams Codeine Syrup - $200 - $400 per pint!

12 Commonly Diverted Drugs – Street Prices DRUGSTATECITY / COUNTY*LOW $HIGH $QUANTITY / WEIGHT Codeine syrupTexasHouston$200.00$400.001 pint Codeine syrup TexasHouston $ 20.00 1 ounce Codeine syrup TexasPlano $ 10.00 1 ounce Codeine syrup Texas $ 35.00 $ 175.001 ounce Codeine syrup Texas $ 20.00 $ 40.001 ounce OxyContin® Texas $ 8.00 $ 35.001 dosage unit OxyContin® Texas $ 25.00 $ 50.001 dosage unit OxyContin® Texas $ 1.00 1 milligram Hydrocodone TexasHouston $ 2.00 $ 5.001 tablet Hydrocodone Texas $ 2.00 $ 10.001 dosage unit Hydrocodone Texas $ 1.00 $ 4.001 dosage unit Alprazolam TexasHouston $ 2.00 $ 4.001 tablet Xanax® TexasHouston $ 2.00 $ 5.001 tablet OxyContin ® - $25 - $50 per pill!

13 Diversion- Popular Culture “Sippin’ on Some Syrup”

14 Pimp C was found dead December 4 in a Los Angeles hotel after headlining a few spot tour dates in California with Too Short. He was 33. Pimp C was instrumental in shaping the sound and influence of Southern rap, which dominates hip- hop today. On "Sippin' on Some Syrup," a track for which UGK collaborated with Three 6 Mafia, Pimp C boasted of his affinity for codeine. Cough medicine combined with a number of mixers is a popular beverage in some Southern regions Diversion - Popular Culture Pimp C – Codeine Syrup Overdose December 4, 2008 Source: MTV.com, December 4, 2008

15 Solutions? State Rules Federal Rules Criminal Investigation & Prosecution Industry Solutions Your Own Private Army?

16 State Solutions Texas Closed Formulary Rules Texas Closed Formulary Rules – 40% of the top 25 Comp Drugs will Require Preauth – “N” Drugs are over 25% of Total Comp Drug Spend Insurance Fraud Bureau of Massachusetts – Mission: to eliminate fraud from the insurance scene in Massachusetts Direction of Care Rules - Nevada – Non Network Prescriptions Just Don’t Get Paid!

17 Federal Solutions April 19, 2011, “Epidemic: Responding to America’s Prescription Drug Abuse Crisis” Framework for reducing prescription drug diversion and abuse Expands state-based prescription drug monitoring programs Enhances disposal methods Supports education for patients and healthcare providers Reduces the prevalence of pill mills and doctor shopping Source:http://www.justice.gov/dea/pubs/pressrel/pr041911.html

18 Criminal Investigation and Prosecution - Florida Leads the nation in diverted prescription drugs - Attorney General’s top priority $10,000 fine for doctors Third-degree felony for those who fraudulently register a pain clinic Criminal penalty for doctors who fail to perform a physical examination Must report theft of controlled substances to local law enforcement in 48 hours

19 Industry Solutions Nalaxone included – prevent abuse Can’t be Crushed or Dissolved in Alcohol Cost is HIGHER Examples – Exalgo™ (hydromorphone extended-release), – Abuse-deterrent Oxycontin® (oxycodone extended- release) – Embeda™

20 Your Private Army - Payer Directed Solutions The Role of the PBM PBM Prevention Formularies Point of Sale Drug Utilization Reviews & Physician Intervention

21 Recruiting and Credentialing Pharmacies Auditing Pharmacy Records Monitoring Pharmacies Monitoring Prescribers Identifying Abuse PBM

22 Summary

23 Questions?

Download ppt "National Council of Self-Insurers 2011 Annual Meeting Dennis M. Sponer, Esq., CEO ScripNet, Inc. www.scripnet.com."

Similar presentations

Trend in Prescription Drug Abuse In 2004, 19.1 million Americans were current illicit drug users (7.9% of the U.S. population) 1 In 2004, 19.1 million.

Trend in Prescription Drug Abuse In 2004, 19.1 million Americans were current illicit drug users (7.9% of the U.S. population) 1 In 2004, 19.1 million.
MAPS Michigan Automated Prescription System. Exempt From Reporting Medications administered directly to patients. Dispensing of up to a 48 hour supply.

MAPS Michigan Automated Prescription System. Exempt From Reporting Medications administered directly to patients. Dispensing of up to a 48 hour supply.
National Prescription Drug Threat Assessment 2009 National Drug Intelligence Center Drug Enforcement Administration.

National Prescription Drug Threat Assessment 2009 National Drug Intelligence Center Drug Enforcement Administration.
America’s biggest drug problem is the use of illicit “street” drugs.

America’s biggest drug problem is the use of illicit “street” drugs.
The purpose of this overview is to update the facts pertaining to the possibility of upward trends related to heroin trafficking and/or abuse in the Commonwealth.

The purpose of this overview is to update the facts pertaining to the possibility of upward trends related to heroin trafficking and/or abuse in the Commonwealth.
A Growing Problem…. We Will Discuss Prescription vs. OTC medications Alarming trends Myths about prescription drug abuse Specific medications of abuse.

A Growing Problem…. We Will Discuss Prescription vs. OTC medications Alarming trends Myths about prescription drug abuse Specific medications of abuse.
Opioid Rescue Kits for Porter County Sheriff’s Department.

Opioid Rescue Kits for Porter County Sheriff’s Department.
Controlling Off-Label Narcotics Usage - Impact of New Arizona Legislation ARS § 23-1062.02.

Controlling Off-Label Narcotics Usage - Impact of New Arizona Legislation ARS §
CDER/CSS ALSDAC September 9-10, 2003 Risk Management and the Controlled Substances Act: The FDA Perspective Deborah B. Leiderman, M.D., M.A. Director Controlled.

CDER/CSS ALSDAC September 9-10, 2003 Risk Management and the Controlled Substances Act: The FDA Perspective Deborah B. Leiderman, M.D., M.A. Director Controlled.
Pain Policy Update Opioid Update Stuart Beatty, PharmD, BCPS.

Pain Policy Update Opioid Update Stuart Beatty, PharmD, BCPS.
Lock Your Meds BE AWARE. DON'T SHARE.. Your Home Medicine Cabinet: Does it look like this?

Lock Your Meds BE AWARE. DON'T SHARE.. Your Home Medicine Cabinet: Does it look like this?
Anesthetic and Life Support Drugs, and Drug Safety and Risk Management Advisory Committees, November 13, 2008 Outpatient Drug Utilization Trends for Oxycodone.

Anesthetic and Life Support Drugs, and Drug Safety and Risk Management Advisory Committees, November 13, 2008 Outpatient Drug Utilization Trends for Oxycodone.
IDAHO RURAL PARTNERSHIP BOARD MEETING THURSDAY, JANUARY 7, 2010.

IDAHO RURAL PARTNERSHIP BOARD MEETING THURSDAY, JANUARY 7, 2010.
CONTROLLED SUBSTANCES ACT Pharmacy 151 Introduction to Pharmacy Law Wayne Brown, Ph.D.

CONTROLLED SUBSTANCES ACT Pharmacy 151 Introduction to Pharmacy Law Wayne Brown, Ph.D.
Dr Nigel Hawkins - UWS.  Prescription opiate abuse is something that all GP’s are familiar with and so all GPs need to know how to manage it  This talk.

Dr Nigel Hawkins - UWS.  Prescription opiate abuse is something that all GP’s are familiar with and so all GPs need to know how to manage it  This talk.
PRESCRIPTION DRUG ABUSE

PRESCRIPTION DRUG ABUSE
1 Public Health Law Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention Pain Management Clinic Laws.

1 Public Health Law Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention Pain Management Clinic Laws.
Lock Your Meds BE AWARE. DON'T SHARE. Sponsored by.

Lock Your Meds BE AWARE. DON'T SHARE. Sponsored by.
Pharmaceutical Drug Abuse Counterfeit Drugs. Current State of Affairs National drug prevalence studies indicate a sharp increase in prescription drug.

Pharmaceutical Drug Abuse Counterfeit Drugs. Current State of Affairs National drug prevalence studies indicate a sharp increase in prescription drug.
LEGAL AND ILLEGAL SUBSTANCES. LEGAL DRUGS Legal drugs are considered permissible for use, and are either prescribed by a physician (prescription medications)

LEGAL AND ILLEGAL SUBSTANCES. LEGAL DRUGS Legal drugs are considered permissible for use, and are either prescribed by a physician (prescription medications)

Similar presentations

Ads by Google