We continue to have falling opioid prices with the latest being the oxycodone formulations. While opioid volume and costs are on a downward trend in utilization, per current drug trends reports, they remain the highest in the top 10 prescribed drugs in the workers’ compensation realm, by spend and utilization. Nearly 25% of injured workers (IW) are on opioids, and based on their highly addictive properties, there is an increased likelihood of becoming a chronic opioid used. According to the Center for Disease Control and Prevention, 1 in 4 patients on opioids for longer than 12 weeks develop signs and symptoms of addiction. A noteworthy significant risk of long-term opioid use is opioid use disorder (OUD). OUD is a chronic disease and the treatment guidelines recommend pharmacotherapy in a medication-assisted treatment, which can potentially last over the IW’s life expectancy. Long term opioid use impacts delayed recovery, return to work, increase in claim cost and duration, and may ultimately prevent claim settlement.

In the face of increasing overdose deaths and as a continued effort to manage damage from the opioid epidemic, the US Food and Drug Administration (FDA) released a news release on 7.23.2020 with a goal to help reduce opioid overdoses and deaths. They require the manufacturers of opioid pain medications and medications to treat OUD to be update their labeling to recommend that a routine part of prescribing these medicines, health care professionals should discuss the availability of naloxone with patients and caregivers. They recommend that health care professionals consider prescribing naloxone when they prescribe medications to treat OUD, and for those who are at increased risk of opioid overdose. 

Please refer to the table below outlining a significant difference in the lowest average wholesale price (AWP) between the previous and current AWP, per CMS’ recognized and approved compendium, Red Book. Updates to the MSA will significantly mitigate Part D allocation and save Workers’ Compensation payers money, facilitate settlement and allow for closure of claims. 

Table 1: Current Pricing Spectrum and Savings as of 8.6.2020

ExamWorks Compliance Solutions’ Doctors of Pharmacy offer opioid risk-benefit evaluation, potential opioid tapers risk mitigation strategies, alternatives to high cost Medicare-covered medications, and clarification of drug regimens to provide the most accurate and defensible MSA. The goal of the program is to impact medication therapy and mitigate MSA drug costs by consulting with the treating provider on the clinical rationale. ECS utilizes technology and compendia databases which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace.  

For questions about medications or the ExamWorks Compliance Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD MSCC at 678.256.5086 or nahla.rizkallah@examworkscompliance.com