Transcript Slide 1

National Council of Self-Insurers
2011 Annual Meeting
Dennis M. Sponer, Esq., CEO
ScripNet, Inc.
www.scripnet.com
Overview
Introduction
Narcotics
– Abuse
– Diversion
Solutions
–
–
–
–
State Solutions
Federal Solutions
Industry Solutions
Payer Solutions
Conclusion
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
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
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.
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.
Large diversion losses affect both traditional health
insurers and workers’ compensation insurers.
Source: Coalition Against Insurance Fraud Publication, Prescription for Peril,
2007
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®)
Diversion – ACTIQ®
breakthrough pain in
adult patients with cancer (16 years and older)
ACTIQ® is used to treat
who are already taking other opioid pain medicines for
their constant (around-the-clock) cancer pain.
. . . 90% of ACTIQ® prescriptions are off label.
Sources: http://www.actiq.com/patients/aboutbtcp/default.asp and
http://www.primetherapeutics.com/pdf/Actiq.pdf
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
Diversion – What do Payers Pay?
ACTIQ® 800 mcg
AWP $82.68
OxyContin® 80 mg
AWP $20.30
Fentanyl 75 mcg
AWP $72.40
Prices are average for a 30 day supply.
Commonly Diverted Drugs –
Street Prices
DRUG
STATE / TERRITORY
LOW $
HIGH $
QUANTITY /WEIGHT
Diazepam
Connecticut
$2.00
$2.00
10 milligrams
Diazepam
Maine
$2.00
$2.00
10 milligrams
Diazepam
Massachusetts
$2.00
$2.00
10 milligrams
Diazepam
New Hampshire
$2.00
$2.00
10 milligrams
Diazepam
Vermont
$2.00
$2.00
10 milligrams
Valium®
Connecticut
$3.00
$5.00
10 milligrams
Valium®
Maine
$3.00
$5.00
10 milligrams
Valium®
Massachusetts
$3.00
$5.00
10 milligrams
Valium®
New Hampshire
$3.00
$5.00
10 milligrams
Valium®
Vermont
$3.00
$5.00
10 milligrams
Commonly Diverted Drugs –
Street Prices
DRUG
STATE
CITY / COUNTY*
LOW $
HIGH $
QUANTITY / WEIGHT
Codeine syrup
Texas
Houston
$200.00
$400.00
1 pint
Codeine syrup
Texas
Houston
$ 20.00
$
20.00
1 ounce
Codeine syrup
Texas
Plano
$ 10.00
$
10.00
1 ounce
Codeine syrup
Texas
$ 35.00
$ 175.00
1 ounce
Codeine syrup
Texas
$ 20.00
$
40.00
1 ounce
OxyContin®
Texas
$ 8.00
$
35.00
1 dosage unit
OxyContin®
Texas
$ 25.00
$
50.00
1 dosage unit
OxyContin®
Texas
$ 1.00
$
1.00
1 milligram
Hydrocodone
Texas
$ 2.00
$
5.00
1 tablet
Hydrocodone
Texas
$ 2.00
$
10.00
1 dosage unit
Hydrocodone
Texas
$ 1.00
$
4.00
1 dosage unit
Alprazolam
Texas
Houston
$ 2.00
$
4.00
1 tablet
Xanax®
Texas
Houston
$ 2.00
$
5.00
1 tablet
Houston
Diversion- Popular Culture
“Sippin’ on Some Syrup”
Diversion - Popular Culture
Pimp C – Codeine Syrup Overdose
December 4, 2008
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 hiphop 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
Source: MTV.com, December 4, 2008
Solutions?
State Rules
Federal Rules
Criminal
Investigation &
Prosecution
Industry Solutions
Your Own Private Army?
State Solutions
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!
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
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
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 extendedrelease)
– Embeda™
Your Private Army - Payer Directed
Solutions
The Role of the
PBM
Prevention
Formularies
Point of Sale
Drug Utilization Reviews & Physician Intervention
Recruiting
and
Credentialing
Pharmacies
Identifying
Abuse
PBM
Monitoring
Prescribers
Auditing
Pharmacy
Records
Monitoring
Pharmacies
Summary
Questions?