The use of narcotics was evidenced in a recent article in theJournal of Workers Compensation, which estimated that narcoticsaccount for an almost 40 percent of workers' compensationmedication costs. And while narcotics can be beneficial in thetreatment plan of an injured worker, there are serious risksinvolved when they are not used properly.

The Centers for Disease Control (CDC) and the Substance Abuseand Mental Health Services Administration (SAMHSA), both indicateincreasing misuse and abuse of narcotics over the past decade.SAMHSA data shows that there was a significant increase from 2000to 2006 in the treatment of substance abuse cases related to abuseof opiod analgesics.

The Narcotics' Quandary

According to the 2009 Progressive Medical Drug Spend Analysis,spending on narcotics has remained relatively stable during thelast year. As indicated earlier, however, narcotics still accountfor nearly 40 percent of all workers' compensation claim costs.

What is even more troubling for workers' compensation insurersis the allocation of that spending. In a study released by theNational Council on Compensation Insurance, narcotics total shareof medication expenses increases as a claim ages, from 15 percentin year one to as much as 35 percent in the fifth year.

Additionally, the longer an injured party is on narcotics, thatmore it delays the injured party's ability to return to work. Therealso is an increased likelihood that the payer may need to pay forrehabilitation programs for addiction.

Take Proactive Measures to Combat Abuse

Because the cost of prescriptions, including narcoticmedications, directly impacts the cost of a workers' compensationclaim, insurers need to quickly identify and control instances ofmisuse and abuse. One of the most efficient methods to controlnarcotic use is to partner with a pharmacy benefit manager (PBM). APBM can clearly define a strategy to proactively and effectivelymonitor narcotics, and help payers ensure the safety of the injuredparty while reducing expenses.

There are several best practices that can be deployed by PBMs toassist payers:

? Defining customized narcotics utilization strategies

? Managing prospective and concurrent drug utilizationprograms

? Conducting retrospective drug utilization reviews and clinicalintervention programs

? Providing ongoing consultation and evaluation of utilizationstrategies

? Validating narcotics use through reporting

It is expected that narcotics will continue to play a role intreating pain in workers' compensation. While greater oversight ofnarcotics use is already underway by the FDA through its new RiskEvaluation and Mitigation Strategies requirement, workers'compensation payers must take proactive measures to reduce misuseand abuse. A relationship with a strong PBM partner experienced inworkers' compensation will enable the payer to monitor utilizationand reduce point-of-sale fulfillment of unnecessary narcotics. Bydoing so, payers decrease risk for litigation, improve injuredparty safety, and obtain more control over medication expenses.

Tron Emptage, RPh, MA, is executive vicepresident of business development at Progressive Medical, Inc. Hemay be reached at [email protected]or 800-777-3574. Company information is available at www.progressive-medical.com.