Opioid painkiller abuse remains at or toward the top of pharmacy concerns for pretty much everyone involved in a health plan participant’s medication – the benefits administrator, the doctor and the insurer. Respondents to the Survey of Prescription Drug Management released by CompPharma, LLC, released earlier this year, said opioids were the biggest problem in workers’ compensation pharmacy management and most had implemented programs to address opioid overuse and abuse.

“Despite relatively flat drug costs, respondents continue to be significantly concerned about the issue,” the report states. “In response to the question ‘How big a problem are drug costs?’ on a 1-through-5 scale with 3 being ‘drug costs are equally as important as other medical cost issues,’ drug costs were rated a 4.1, or ‘more important than other medical cost issues.’”

Dr. Brian Solow, chief medical officer of pharmacy benefit manager Optum Rx, says focusing only on cost is a mistake. Some of the cheapest drugs, he points out, can do the most damage in terms of personnel issues.

“You’re talking about two issues, of course,” Solow says. “The employer who’s worried about high-cost abuse, drugs, etc. But there are also drugs that are very inexpensive that are being abused, but that really don’t cost the employer anything in terms of monetary drug value. … I think people lose sight and think we’re always trying to catch it because it’s less expensive, but generic Codeine, generic Vicodin – these are actually pretty cheap. So, I think that’s where we’re going to have to turn to their pharmacy benefit manager.”

Solow says “It’s a very unique position that PBMs hold” and employers who try to take on too much pharmacy administration on their own are missing a key mediator. Neither doctor nor HR department is likely to know when a patient is getting Vicodin from three different sources, he says.

“We’re sending the message to the physician, we’re saying to them, ‘Hey, this patient may require some additional evaluation, as determined by an analysis we’ve done on claims.’ So they actually get an individual report on each of those members,” he says.

For more of Dr. Solow’s advice on working with your PBM, pick up the Sept. 15 issue of EBN.


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