While workers' compensation insurers and risk managers arereporting extraordinary success in lowering the frequency ofjob-related injuries, getting a handle on severity is anotherstory–especially when dealing with complicated claims involvingchronic pain. What's required is appropriate monitoring andcontrols over the utilization of expensive, potentially dangerousand often counterproductive prescription drugs.

Such cases caninvolve complex nuances–including multiple symptoms, chronicanxiety or depression, changes in anger control, various lifestylechanges, and increased tolerance for pain medication, just to namea few.

A case-by-case basis monitoring of prescription drug utilizationis needed for good oversight of such claims.

Within chronic pain cases in workers' comp, as within healthcare in general, medications are typically an effective andcost-saving form of therapy.

However, such treatment doesn't come cheap, as prescriptionsaccount for 19 percent of workers' comp expenses on average,according to a National Council on Compensation Insurance “Winter2009″ study. Indeed, prescriptions associated with chronic pain maycomprise 30-to-40 percent of a comp claim.

Containing these costs is critical for comp insurers, as costscan rise quickly over the lifecycle of a claim.

Many long-term claims involving chronic pain (and their oftenassociated higher utilization of pain medications) lead toincreased costs over time.

According to a 2007 NCCI report, prescription drugs typicallyaccount for 3 percent of costs on the claim in the first year. Butafter a seven-year lifespan of the claim, the percentage jumps to31 percent.

In addition to the challenges of heightened medication costs,overuse of pain medication–specifically opioid use–have shownadverse effects on the overall well-being and treatment of injuredparties.

High levels of opioid use have been associated with a highprevalence of adverse outcomes, increased lost time from work anddelayed recovery.

Higher utilization levels for opioids can have an adverse impacton both activity levels and on self-sufficiency. Prolongedadministration may impede, rather than facilitate, an injuredworker's recovery from occupational injuries.

Drug costs associated with chronicpain in workers' comp claims may be decreased using a variety ofmethods, including substituting generic equivalents for brand-namemedications and leveraging pharmacy network discounts. However,savings from these two methods are irrelevant if the medicationshould not have been dispensed in the first place.

It is important to ensure that all medications dispensed areappropriate for each chronic pain case. This can be accomplished byhaving medical professionals review the injured worker'stherapy.

One solution that payers should take a closer look at ismedication therapy management, which enables a pharmacist tooptimize an injured party's medications, minimizing complicationsor interactions.

The purpose of the medication therapy management concept–whichwas originally established by the Medicare Modernization Act of2003–is to ensure that medication therapy is individualized to meetthe unique needs of the injured party in workers' comp.

To effectively manage medication therapy, insurers andself-insured employers should analyze the injured party's medicalhistory, conduct a comprehensive medication review, look foradverse drug events and carefully monitor drug therapyoutcomes.

Based on this initial review, the pharmacist can makerecommendations for modifying medication therapy and communicatepotential alternative treatment plans to other providers–includinginsurers, physicians and retail pharmacists–to improve on theinjured party's medication outcomes.

Recently, Progressive Medical conducted a study that examinedmedication therapy management reports completed between July 2007and July 2008 for a group of workers' comp claims in onejurisdiction.

We found that 90 percent of the reviewed claims had at least oneinappropriate medication approved on the claim, while 56 percenthad prescription dosages that required modification.

What's more, if every clinical pharmacist's recommendation wasfollowed, as reviewed and approved by the treating physician, theaverage per-claim savings could amount to more than $6,000annually.

In chronic pain cases, not only will the recommendations ofpharmacists result in reduced costs, they may also improve thetherapeutic outcome for injured parties who experience adverseeffects from pain medications.

One recent medical study found that a collaborative strategy forchronic pain management–including patient and primary care doctoreducation as well as frequent reevaluation of the painplan–provided better relief of pain compared to standard care.

A medication therapy management strategy should effectively meetan insurer's cost-containment objectives. This type of program isgenerally appropriate for claims that involve chronic paintreatment resulting from injury, have excessive medications, or aremore than three years old and show a history of more than oneprescribing physician.

In these types of chronic pain cases, it becomes increasinglyimportant for all parties to note changes in behavior to identifyred flags. It is also important for claims professionals,pharmacists providing medication therapy management and prescribingphysicians to have direct communication regarding recommendationsfor treatment.

Here's an example of how a chronic pain claim works:

A woman who suffered a right-elbow job-related injury underwentmultiple surgeries but still had chronic pain in her elbow andshoulder as well as limited elbow movement. She was prescribed fivemedications, which caused subsequent conditions of depression andanxiety.

A clinical pharmacist's comprehensive review of the injuredwoman's medical records and prescription history determined she wasbeing inappropriately treated for insomnia.

The pharmacist and physician recommended elimination of a drugfrom her regimen, along with treatment for insomnia and depressionwith a nondrug therapy. As a result, by reducing a medication andincorporating nonpharmacologic therapy, the insurer reduced theannual cost of her claim.

With the U.S. Bureau of Labor Statistics reporting more thanfour million workers injured on the job each year, payers arelooking for ways to reduce costs.

Engaging in a medical therapy management program that includesclinical review by a pharmacist can often result in cost savings oftens of thousands of dollars.

This approach also ensures that injured parties receiveappropriate medications to help them get back to work morequickly.

Tron Emptage, RPh, is executive vice presidentof business development at Progressive Medical Inc. in Westerville,Ohio. He can be reached at [email protected],or 800-777-3574.