A family matter required my full attention last week, which was why you didn’t see any new posts on Managed Care Matters. A lot happened which we’ll reprise here quickly.
Alex Swedlow of CWCI published another report on the ongoing disaster in California, namely the rampant overuse of narcotics by workers comp claimants. This latest update focused on the use of fentanyl, a narcotic that is between 75 and 100 times more potent than oral morphine.
Fentanyl is NOT indicated for musculo-skeletal injuries, yet it was prescribed for almost 3500 claims out of the total population of sixteen thousand plus claims. Fourteen hundred claims with the diagnosis of ‘medical back problems without spinal cord involvement’ were prescribed fentanyl.
As with the top opioid prescribers, the top ten percent of docs writing scripts for fentanyl wrote the vast majority – in this case 84% of all scripts came from 917 docs, with the average doc writing over fifty scripts for fentanyl.
Actiq and Fentora are orally-administered versions of fentanyl – and are NOT FDA approved for injuries or conditions occurring in workers comp. Nevertheless, Swedlow et al found 77 claimants had scripts for these two wildly expensive drugs.
The ongoing effort to reform work comp in Illinois seems to be moving more sideways than forwards, with competing proposals and bills, intensive lobbying, and a bit of disarray on the business side all contributing to a very, very murky picture.
Meanwhile, there was a bit of good news on the work comp pricing front, as MarketScout reported that they are seeing more favorable pricing trends of late with rates essentially flat in March after pricing firmed in previous months. This mirrors news from the broader property and casualty lines, which, while still pressured by abundant capacity, seem to be showing more resistance to price concessions.
Finally, thanks to Sandy Blunt for the tip – USAToday ran an editorial last week noting 18,000 people a year die from prescription drug abuse. Eighteen thousand.
For the first time in many years, MCM won’t be reporting ‘live’ from the RIMS conference. Too much going on to attend the annual property and casualty confab – work and the west coast location – and the conflict with NCCI’s annual issues symposium later this week make it impracticable to get to Vancouver.
For those going to RIMS, have fun in Vancouver – and make sure to try the sushi – it’s outstanding.
May
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