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Pharmacy Management

Leveraging PDMPs in the Opioid Battle

Prescription monitoring programs are a prime tool in the fight against opioid abuse. Unfortunately there are barriers to access.
By: | February 24, 2017 • 4 min read

Many of those in the industry may have read the recent musings of Judge Langham, the Deputy Chief Judge of Compensation Claims for The Florida Division of Administrative Hearings regarding the drug abuse crisis we have in our industry and the deaths resulting from that crisis.

He notes, “The bottom line is that drugs are directly killing people, lots of people. The 2015 total of 55,403 deaths from drugs comes out to an overdose death about every 9.5 minutes all day long.” Shocking!

We, in our industry, have certainly put a lot of focus on the opioid epidemic in workers compensation but as Judge Langham points out, it’s not just opioids we need to worry about. As he notes, the use of pharmaceuticals is staggering — there are deadly combinations of multiple drugs as well as drugs and alcohol that are killing our injured workers and sometimes their family members as well.

The pharmacy benefit management programs we all utilize are doing a good job of controlling workers’ comp pharmacy costs and identifying inappropriate or unapproved medications and high MED (Morphine Equivalent Dose) levels insofar as they know.

Our stove-piped insurance programs keep these PBMs in the dark about all the drugs a particular injured worker might be taking, i.e. the right hand and the left hand not knowing what the other hand is doing.

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What can we do about this; you ask? That is where the PDMPs come in.

PDMPs, or prescription drug monitoring programs, collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners, no matter the insurance coverage.

The data is used to support states’ efforts to educate, research, enforce and prevent abuse and diversion. PDMPs are managed by the individual states. Forty-nine states, the District of Columbia and one U.S. territory (Guam) currently have a PDMP that is operational (meaning collecting data from dispensers and reporting information from the database to authorized users).

The PDMP provides nationwide information about prescriptions that are being filled: their strengths, dosages and quantities; the prescribing physicians; the pharmacies that are filling them; and when they are being filled.

Bottom line, your PBM does not have the whole picture concerning an injured worker’s pharmaceuticals.

Per state law, PDMPs monitor controlled substances as defined by Federal and State Controlled Substances Laws. Some PDMPs also monitor additional drugs of concern. You can find out which drugs are monitored by a specific state by going to this website: www.pdmpassist.org.

Recent studies have shown that when states require mandatory reporting, it cuts down on abuse and leads to improved outcomes.

For example, in 2015, there were 439 total drug deaths in New Hampshire, of which 397 were caused by opiates/opioids. If nothing had changed, the state was on a path to hit 500 opioid related deaths in 2016. On June 7, 2016, Governor Hassan signed House Bill 1423, which mandates the use of the prescription drug monitoring program when initially prescribing an opioid and at least twice a year thereafter.

Their 2016 annual report showed that the PDMP is beginning to have positive effects on their opioid epidemic. Prescriptions for schedule II drugs, such as opioids, went down by almost 13% and the number of patients that were flagged for potential doctor shopping (using 5 or more doctors or pharmacies for prescriptions) decreased from 9/month to 3/month.

So you are probably thinking that this is just what we need, a way to look across insurance programs to identify inappropriate drug dispensing/usage and individual injured workers who may be at serious risk.

State law determines access to PDMP information. Most states only allow physicians and dispensing pharmacists to obtain PDMP reports on patients under their care. This allows the treating physicians and dispensing pharmacists an opportunity to intervene with the physician and the injured worker prior to dispensing a controlled substance if the PDMP suggests this might not be safe or in the injured worker’s best interest.

States may also provide PDMP information to other authorized groups such as law enforcement or licensing or regulatory boards but not to pharmacy benefit managers who are third party participants and not considered part of the injured workers treatment team.

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Bottom line, your PBM does not have the whole picture concerning an injured worker’s pharmaceuticals.

What do you need to do?

Take a look around, as there are new players in this PBM market who are taking this problem we have with controlled substances seriously and adding experienced dispensing pharmacists with access to this tool to their program on cases that appear to be at risk.

But keep this in mind as well. Knowing about all the injured worker’s prescribed controlled substances before dispensing is one thing. Providing clinical interventions once you know and before the controlled substance is dispensed is the real key to better outcomes.

Maddy Bowling is a principal in Maddy Bowling Consulting, Inc., a WC consulting firm. Bowling has 35 years of broad-based executive management experience within operating, corporate and consulting environments. She can be reached at [email protected]

Risk Management

The Profession

The risk manager for Boyd Gaming Corp. says curiosity keeps him engaged, and continual education will be the key to managing emerging risks.
By: | May 1, 2018 • 4 min read

R&I: What was your first job?

I was trained as an accountant, worked in public accounting and became a CPA. Being comfortable with numbers is helpful in my current role, and obviously, the language of business is financial statements, so it helps.

R&I: How did you come to work in risk management?

Working in finance in the corporate environment included the review of budgets and the analysis of business expenses. I quickly found the area of benefits and insurance — and how “accepting risk” impacted those expenses — to be fascinating. I asked a lot of questions. Be careful what you ask for — I soon found myself responsible for those insurance areas and haven’t looked back!

R&I: What is the risk management community doing right?

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I have found the risk management community to be a close-knit group, whether that’s industry professionals, risk managers with other companies or support organizations like RIMS and other regional groups. The expertise of the carriers and specialty vendors to develop new products and programs, along with the appropriate education, will continue to be of key importance to companies going forward.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

As I’m sure many in the insurance field would agree, Hurricanes Katrina and Rita in 2005 changed our world and our industry. It was a particularly intense time and certainly a baptism by fire for people like me who were relatively new to the industry. This event clearly accelerated the switch to the acceptance of more risk, which impacted mitigation strategies and programs.

Bob Berglund, vice president, benefits and insurance, Boyd Gaming Corp.

R&I: What emerging commercial risk most concerns you?

The fast-paced threat that cyber security represents today. Our company, like so many companies, is reliant upon computers, software and IT expertise in our everyday existence. This new risk has forged an even stronger relationship between risk management and our IT department as we work together to address this growing threat.

Additionally, the shooting event in Las Vegas in 2017 will have an enduring impact on firms that host large gatherings and arena-style events all over the world, and our company is no exception.

R&I: What insurance carrier do you have the highest opinion of?

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With the various types of insurance programs we employ, I have been fortunate to work with most of the large national and international carriers — all of whom employ talented people with a vast array of resources.

R&I:  How much business do you do direct versus going through a broker?

We use brokers for many of our professional coverages, such as property, casualty, D&O and cyber. We are self-insured under our health plans, with close to 25,000 members. We tend to manage those programs internally and utilize direct relationships with carriers and specialty vendors to tailor a plan that works best for team members.

R&I: Who is your mentor and why?

I have been fortunate to have worked alongside some smart and insightful people during my career. A key piece of advice, said in many different ways, has served me well. Simply stated: “Seek to understand before being understood.”

What this has meant to me is try everything you can to learn about something, new or old. After you have gained this knowledge, you can begin to access and maybe suggest changes or adjustments. Being curious has always been a personal enjoyment for me in business, and I have found people are more than willing to lend a hand, offer information and advice — you just need to ask. Building those alliances and foundations of knowledge on a subject matter makes tackling the future more exciting and fruitful.

R&I: What have you accomplished that you are proudest of?

Our benefit health plan is much more than handing out an insurance card at the beginning of the year. We encourage our team members and their families to learn about their personal health, get engaged in a variety of health and wellness programs and try to live life in the healthiest possible way. The result of that is literally hundreds of testimonials from our members every year on how they have lost weight, changed their lifestyle and gotten off medications. It is extremely rewarding and is a testament to [our] close-knit corporate culture.

R&I: What’s the best restaurant you’ve ever eaten at?

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Some will remember the volcano eruption in Iceland in spring of 2010. I was just finishing a week of meetings in London with Lloyd’s syndicates related to our property insurance placement when the airspace in England and most of northern Europe was shut down — no airplanes in or out! Flights were ultimately canceled for the following five days. Therefore, with a few other stranded visitors like myself, we experimented and tried out new restaurants every day until we could leave. It was a very interesting time!

R&I: What is the riskiest activity you ever engaged in?

I am originally from Canada, and I played ice hockey from the time I was four years old up until quite recently. Too many surgeries sadly forced my recent retirement.

R&I: What do your friends and family think you do?

That’s a funny one … I am a CPA working in the casino industry, doing insurance and risk management, so neighbors and acquaintances think I either do tax returns or they think I’m a blackjack dealer at the casino!




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]