Pharmacy Benefits Managers Can Help Control Narcotics Expenses, Expert Says

Prescription drug abuse has become a leading concern. Some studies indicate it is more prevalent than illicit drug use. The issue is especially significant in the workers' comp system.

"Most of our claimants are in pain, so narcotics have long been the treatment of choice," said Tron Emptage, executive vice president of Progressive Medical in Westerville, Ohio. "That's been an increasing problem and a long-standing treatment plan."

In addition to trying to steer claimants clear of narcotics in the first place, employers can look for ways to control those costs for workers who are taking them.

"They can capture all the data in one spot so it can be analyzed and trends found," Emptage said. "From those trends, we can find outlier physicians, outlier claimants, outlier pharmacies to pinpoint where problems or challenges are or which claimants are really overusing narcotics."

According to Emptage, effective pharmacy benefit managers can alert their clients to potential red flags, such as when a particular client's first narcotics prescription is filled.

"We also send out an alert when the narcotic is taken at a higher level than is normal," Emptage said. "It's how we target those areas."

A drug utilization program also helps keep narcotics abuse in check. Emptage said Progressive's system includes several phases. In the prospective portion, medication plans -- formularies -- are developed by a team of physicians, pharmacists and nurses using evidence-based guidelines to assure only specific medications are prescribed for particular injuries.

Clients receive alerts throughout the life of a claim that are later translated into retrospective reviews to show what has happened with particular claimants and to determine how to better assist clients in the future.

During an intervention prescription phase, the PBM focuses intently on particular claimants. "It consists of several different reports and programs based on individual claimants they believe are problem claimants or filling extra trips [to a pharmacy] to develop a better treatment plan for that particular claimant," he said. "It's generally pulled together from our internal reporting and outlier reports." The idea, he said, is to get a better overall picture of the claimant.

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