CWCI has published a research piece suggesting that 3rd party payer access to the CURES database (Controlled Substance Utilization Review and Evaluation System) - California's Prescription Drug Monitoring program - could create material cost savings for the California work comp system.
California is on the verge of pulling the plug on CURES. Despite significant evidence from across the nation that Prescription Drug Monitoring Programs (PDMPs) are critical to fighting the inappropriate utilization of opioids, California has yet to commit to the $3.7 million in annual funding necessary to keep the system online. If funding doesn't materialize before this summer, the database will go offline in July.
So why should a state with a massive budget deficit throw $3.7 million at a database? Perhaps because it would save 15X that number if the database was accessible and usable by 3rd party payers. The analysis from CWCI is characterized as conservative, but still suggests potential savings (ranging from 3% to 7%, depending on the complexity of the claim) of nearly $60 million simply through the elimination of fraud and abuse by 3rd party payers having access to critical data not currently available to them.
Before the chorus of "privacy concerns" erupts, keep in mind that CWCI is merely suggesting that payers be granted access to data regarding services and therapies for which they are most likely already paying. The aggregation of the data by prescriber and by pharmacy offers insight into inappropriate and/or unsafe activities such doctor shopping, pharmacy shopping, drug-drug interactions, etc. and can serve as a powerful tool that an individual payer can use to help manage care more effectively.
Pain management guidelines don't appear to be working (that's a post for another time) and the study found that 41% of work comp claims end up with at least one opioid script, with >20% of injured workers receiving at least 7 opioid scripts over a 24 month period.
That's a lot of drugs. And a $3.7 million database with a potential for a $60 million return sounds like a good investment to me.
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