Tuesday, October 15, 2013

Rx Abuse: Where Does Your State Stand?

The National Safety Council just released its report on state efforts to combat prescription drug abuse.  The news is not good.  According to the report, only three states (Washington, Kentucky, and Vermont) met the standards outlined in the report. 

A few observations:

First, the standards established by the report are a good, solid start for preventing prescription drug abuse.  They include assessment of Prescription Drug Monitoring Programs (PDMPs), how states deal with pill mills, whether states have clear prescribing guidelines, and what states are doing to educate prescribers.  Let's keep in mind, these are the basic building blocks of prevention, not aspirational, unattainable goals.  And yet we have 47 states that can't get their act together.

Second, ask yourself why that is?  What's preventing those 47 other states from enacting the legislative and regulatory changes needed to help prevent prescription drug abuse.  Ask yourself which groups are standing in the way of necessary change. 

Third, ask yourself why workers' comp carriers and self-insured employers can't lead out on this issue at the state level?  I know, laughable.  Work comp leading the way?  In what parallel universe am I living?

Think about it, though. 

Work comp experiences this problem in a very unique way.  The vast majority of medical issues faced in our industry are fundamentally related to pain.  We should be getting better at managing it, right?  At a minimum, we should be learning from our mistakes. 

We have great guidelines.  Some are better than others, but overall, we've spent a lot of time in work comp over the last several years developing the tools we need to assess the medical necessity of medications.

We have a somewhat insulated regulatory bubble that allows us to experiment with new ideas.  The Texas Closed Formulary is a great example.  Look what happens when you require pre-authorization for a certain set of drugs.  Lots of those drugs never get prescribed.  How can we translate that idea into the broader fight against drug abuse?

PDMPs are a great concept, but only insofar as prescribers are using them.  Outside of Kentucky, New York, Massachusetts, and Tennessee, consulting the PDMP before writing a script is optional.  How can work comp payers (and their vendors) influence the voluntary use of PDMPs?  We ask about it on every peer review we conduct.  If the information is there, why wouldn't you look?

Think about it.

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