1. health and fitness
2. drugs

2015
WORKERS’ COMPENSATION
DRUG TRENDS REPORT
Welcome
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Who We Are
Healthcare Solutions, the parent company of Cypress Care, Procura Management,
ScripNet and Modern Medical, is a leading, national provider of integrated medical
cost management solutions for the workers’ compensation and auto/PIP markets.
INSURANCE
CARRIERS
PHARMACY & CLINICAL
MANAGEMENT
THIRD PARTY
ADMINISTRATORS
(TPAs)
MANAGED CARE
ORGANIZATIONS
(MCOs)
ANCILLARY
HEALTH SERVICES
GOVERNMENT
AGENCIES
PPO NETWORKS &
MEDICAL
BILL REVIEW
SELF-INSURED
EMPLOYERS
CASE
MANAGEMENT &
MEDICARE SET-ASIDES
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Speakers
Moderator:
Nancy Hamlet
Senior Vice President, Marketing
Presenters:
Robin Thompson, RPh
Director of Clinical Services
[email protected]
Benjamin Link, PharmD, RPh
Clinical Pharmacist
[email protected]
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Agenda
• Overall Trends
• Ongoing & Evolving Issues
• Therapeutic Class Trends
• Regulatory Landscape
• Key Takeaways
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Overall Trends
12.5%
7.9%
Brand Drug
AWP Price
Generic Drug
AWP Price
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Overall Trends
*Drug Mix = Increased generic use with a decrease in brand drug usage
Healthcare Solutions’ clinical programs helped lower the impact of AWP inflation.
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Percent Savings of Drug Cost at Time of Generic Release
PERCOCET
LIDODERM®
CYMBALTA®
Today’s generic releases
produce less savings.
70%
17%
Previous Generic
Releases
13%
New Generic
Releases
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Number of Generic Manufacturers
Generic Competition and Drug Prices
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94%
2
52%
3
44%
4
39%
5
33%
6
26%
7
23%
8
21%
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20%
0%
20%
40%
60%
80%
100%
Average Relative Price per Dose
Graph adapted from U.S. Food and Drug Administration website.
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Generic Dispense Rate (GDR)
Research indicates, for every 1% increase in GDR,
clients save 1.3%.1
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Liberman, J.N., & Roebuck, C. (2010). Prescription drug costs and the generic dispensing ratio. J Manag Care Pharm. 16(7):502-06.
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Ongoing and Evolving Issues
 Specialty Medications
 Compounds
 Opioids
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Specialty Drugs
What are specialty drugs?
Medications that have one or more of the following characteristics:
 Special handling instructions
 Complex administrations
 Monitoring requirements
 High costs
 Treat complex/chronic disease states
The Issue:
 Cost
1212
Hepatitis C
Comparative Costs of Previous and Current Hepatitis C Treatments
Once more terminal than HIV, Hepatitis C can now be cured in the majority of cases.2
2 Ward, J. (2014). Hepatitis c: 25 years from discovery to cure. Retrieved from http://www.medscape.com/features/slideshow/hepatitis-c.
Registration and login required.
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The Solution
 Specialty Medication Network
provides discounted rates and
management oversight
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Future Consideration: Biosimilars
Biosimilars vs. Traditional Generic Medications Manufacturing Process
Up-front investment by
manufacturers most likely
will lead to reduced cost
savings for biosimilar
medications.
Neupogen, a brand name
biologic product, has a cost
between $350-$400 per dose.
Traditional generic
medications cost less to
produce, resulting in higher
cost savings.
Zarxio, the first biosimilar product approved
in the U.S., does not currently have pricing;
however, an equivalent product released in
Europe, had a price discount of 26%.
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Compounds
The Issue:
 In the past 4 years, the average cost of compounds has escalated 225%,
with paper bill and point of sale costs increasing 317% and 214%
respectively.
$1,500
$1,200
$900
$600
$300
$0
2011
2012
2013
2014
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Compounds
The Solution:





Gate 1: Establish a PBN in California
Gate 2: Utilization Review
Gate 3: Compound Medication Review
Gate 4: Peer Review
Gate 5: Independent Medical Examination
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Top Therapeutic Drug Classes
 Opioids
 Anti-Inflammatories
 Skeletal Muscle Relaxants
 Anticonvulsants
 Antidepressants
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Top Opioid Drugs
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Opioids
The Issue:
 Hydrocodone with
acetaminophen
combination products
(HCPs) were rescheduled
from a Schedule III to a
Schedule II.
 Oxycodone with
acetaminophen’s AWP
increased 160% by the
end of 2014.
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Opioids
The Solution:
 Early intervention produces greater results
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Top Anti-Inflammatory Drugs
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Anti-Inflammatories
The Issue:
 The reclassification of HCPs likely
caused spend and utilization to
increase for this drug class.
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Anti-Inflammatories
The Solution:
 Medication Reviews
Looking Ahead:
 The generic release of
Celebrex® is expected to
result in decreased spend for
clients in the coming year.
+
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Top Skeletal Muscle Relaxant Drugs
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Skeletal Muscle Relaxants
The Issue:
 This drug class is commonly used
in the treatment of work-related
injuries; however, product
labeling and guidelines do not
recommend chronic use of most
muscle relaxants.
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Skeletal Muscle Relaxants
The Solution:
 Physician Intervention Letter
CASE STUDY: Physician Intervention Letter
CLAIMANT:
46 year old male
INJURY:
Low back and neck pain
PROBLEM:
Extended use of carisoprodol (Soma) from two
prescribers
SOLUTION:
Physician intervention letter sent
RESULT:
Both prescribers ceased prescribing
carisoprodol; resulting in a savings of 5% on the
claim
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Top Anticonvulsant Drugs
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Anticonvulsants
The Issue:
 Lyrica® has seen an increase in
AWP of 20%, contributing to
49.4% of spend for this drug
class.
 Generic Lyrica® will not be
available until 2018.
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Top Antidepressant Drugs
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Antidepressants
The Issue:
 Cymbalta® and its generic,
duloxetine represent the most
common drug within this drug
class.
 Antidepressants are
historically a difficult drug
class to manage.
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Anticonvulsants & Antidepressants Solutions
The Solutions:
 Step Therapy
 Clinical Liaison
$
$$
Nno texto
$$$
Lyrica®
Gabapentin
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Regulatory: ODG Formulary
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Key Takeaways
Generic/AWP Inflation:
 8.6% increase in AWP – 4.5% program offset = 4.1% increase in total spend
Specialty Medications:
 New higher cost specialty medications may impact spend in the future
 Specialty medication networks provide discounted rates and management
oversight
Compounds:
 There was a rise in the number, complexity and cost of compounds in 2014
 Utilize the appropriate tools to mitigate the rising costs
Opioids:
 Continues to be the top therapeutic drug class by spend and utilization
 Early intervention produces greater results
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Your PBM Partner
Our governmental affairs department monitors daily activity; conducts
outreach; and participates in public hearings, teleconferences and meetings
to ensure the best possible solutions are adopted for clients and injured
workers.
Healthcare Solutions will continue to develop innovative clinical programs
to help lower your medical spend and increase claimant safety.
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Please submit questions through the attendee control
panel located on the right-hand side of your screen
Additional Questions?
Please email [email protected]
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Thank you
Robin Thompson, RPh
Director of Clinical Services
[email protected]
Benjamin Link, PharmD, RPh
Clinical Pharmacist
[email protected]
Please send your questions, comments and feedback to:
[email protected]
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