Workers Compensation Matters

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1 Workers Compensation Matters Fall 2012 In This Issue 2012 Conferences pg. 2 Ongoing OASIS Enhancements pg. 2 Compliance Update pg. 3 Innovative Injured Workers Pilot Shows Great Success pg. 5 Team Spotlight: Tim Pokorney pg. 6 FDA Approves Long-Acting Opioid REMS Program On July 9, the U.S. Food and Drug Administration (FDA) approved the long-awaited Risk Evaluation and Mitigation Strategies (REMS) program designed for long-acting opioid narcotics. REMS policies are mandatory programs to provide education about and safety awareness of certain classes of high-risk medications. The program was initiated as part of the 2011 Prescription Drug Abuse Prevention Program, designed by the White House Office of National Drug Control Policy. The program mandates that manufacturers of select long-acting narcotics must offer continuing education programs to help prescribers weigh the medications risks and benefits, and identify misuse, addiction and abuse. The courses must be reviewed and approved by a third party to guard against commercial bias and ensure that mandatory components are covered. Currently, prescriber participation is voluntary; however, some groups would like to see the education required in order to prescribe longacting opioids. Manufacturers are required to educate patients on how to safely take, store and dispose of these medications. They provide handouts containing this information to pharmacies for distribution with each prescription. The following medications are now part of the REMS Long-Acting Opioid Program: Avinza Butrans Dolophine Duragesic Embeda Exalgo Kadian MS Contin Opana ER Oramorph OxyContin

2 2012 Conferences September Western Occupational Health Conference: Sept , San Francisco CA Workers Compensation Risk Conference: Sept , Dana Point, Calif. October Wisconsin WC Forum: Oct , Pewaukee, Wisc. Tropics Conference: Oct , Lido Key, Fla. November National WC/Disability Expo: Nov. 6-8, Las Vegas, Nevada Ongoing OASIS Enhancements Express Scripts understands the day-to-day challenges of managing claims and strives to develop opportunities to improve efficiency with enhancements to OASIS, our prior authorization tool. We are excited to announce that OASIS is about to become even more efficient and easier to use. We want to ensure that people handling claims have the tools they need to respond in a timely fashion so that injured workers receive their medication as quickly as possible, says Hollie Bowyer, director, Product Management for Workers Compensation. Many of the OASIS enhancements we re making today stem from client feedback, as well as the anticipation of their future needs. Express Scripts is creating new solutions to help clients better manage their pharmacy claims in the mobile environment as well. The enhancements are scheduled to be released later this fall and include: authorization at different drug levels improved efficiency for navigating through My Queue additional data on the Medication tab view and edit a previously-addressed prior authorization the ability to prevent authorization from escalating 2

3 Compliance Updates California: Electronic and Standardized Billing Regulations The California Division of Workers Compensation (DWC) adopted regulations to standardize paper medical treatment billing forms and electronic medical billing standards. Provisions relating to paper billing became effective Oct. 15, 2011; electronic billing provisions become effective Oct. 18, Updated Pharmaceutical Price Files Posted Between Fall 2011 and Spring 2012, the DWC was unable to post updated pharmaceutical fees to their website due to a delay in the availability of Medi-Cal pharmaceutical price data. The Department of Health Care Services indicated that, beginning May 2012, the weekly pharmaceutical fee data file sent to the California DWC includes all national drug code (NDC) price updates that were missing due to the temporary unavailability of average wholesale prices (AWP) from First Data Bank between Sept. 1, 2011 and March 14, Proposed State Reporting Penalty Language The DWC drafted regulations providing administrative penalties for Workers Compensation Information System (WCIS) reporting violations. In October 2011, Senate Bill 826 was signed into law, amending sections and of the California Labor Code. The bill authorizes the California DWC to assess administrative penalties for claims administrators failure to comply with WCIS reporting requirements. sb_ /sb_826_bill_ _chaptered.pdf Colorado: Proposed changes to Medical Fee Schedule and Treatment Guidelines The Colorado DWC drafted amendments to the Workers Compensation Rules of Procedure. WorkComp/CDLE/ Connecticut: Adopts Repackaged Drug Language The Connecticut Workers Compensation Commission has decided to limit the price of repackaged drugs as part of the state s medical fee schedule, effective July 15, Louisiana: Adopts Pharmacy Electronic Billing Standards The Louisiana Workforce Commission, Office of Workers Compensation adopted legislation to establish electronic billing standards under LAC 40:I.Chapter 3. Maryland: Withdraws Proposed Pharmaceutical Fee Schedule The Maryland Workers Compensation Commission decided to remove the proposal to amend Regulations.01 and.04, and new Regulation.09 under COMAR Guide of Medical and Surgical Fees. Michigan: Proposed Repackaged Drug Language The Michigan Department of Licensing and Regulatory Affairs, Workers Compensation Agency proposed changes to its Health Care Services Rules. ORR/1005_ LR_orr-draft.pdf Disclaimer: The information contained herein is general in nature and should not be construed as legal advice to be applied to any specific factual situation. As the law differs in each jurisdiction and may be interpreted or applied differently depending on your location or situation, you should consult a lawyer if you have any questions. Express Scripts is not providing legal advice. 3 Continued on next page

4 Compliance Update Continued New York: Emergency Regulations continue to be re-adopted, with most recent Emergency Regulation effective June 11, 2012 through Sept. 10, 2012 The Workers Compensation Board continues to re-adopt the Subchapter M emergency regulations created to address pharmacy and durable medical goods. The latest version is effective June 11, 2012 through Sept. 10, Emergency/SubchapterM_ jsp North Carolina: Proposal to establish Electronic Billing Rules The North Carolina Industrial Commission proposed to implement electronic medical billing provisions for workers compensation. Electronic%20Billing%20-%20OAH.pdf Tennessee: Adopts changes to Pharmacy Fee Schedule Guidelines The Tennessee Department of Labor and Workforce Development, Division of Workers Compensation adopted changes to its Pharmacy Schedule Guidelines ( ), effective June 10, Texas: Adopts changes to Pharmacy Fee Schedule Guidelines The Texas Department of Insurance (TDI), DWC adopted rules to amend 28 TAC (General Rules for Medical Billing and Processing), , , (Medical Bill Processing/Audit by Insurance Carrier), (Dispute of Medical Bills) and (Prospective and Concurrent Review of Health Care), effective July 1, documents/ao m.pdf Disclaimer: The information contained herein is general in nature and should not be construed as legal advice to be applied to any specific factual situation. As the law differs in each jurisdiction and may be interpreted or applied differently depending on your location or situation, you should consult a lawyer if you have any questions. Express Scripts is not providing legal advice. 4

5 Innovative Injured Worker Pilot Shows Great Success Express Scripts works with clients to provide a pharmacy program focused on safety, while managing drug spend by converting brand-name drugs to generics whenever clinically appropriate. Traditionally, interventions such as the Physician Outreach Program (POP) letters to physicians, genericmandate edits viewed by pharmacists at the point of service, or step therapy are successful in increasing our clients generic fill rates (GFR). However, because injured workers are not required to pay for their medications, there is no financial incentive to move to generics. Conventional wisdom has been that communicating with the injured worker about switching to generics was fruitless. That is, until now. In February 2012, Express Scripts ran a randomized control trial to test whether or not a letter to injured workers would increase generic conversions, despite a lack of any financial benefit to the worker by doing so. Using tested Consumerology principles, Express Scripts crafted new letters to injured workers testing two differing messages against a control group that did not receive any direct communication: An authority message from a physician to an injured worker, emphasized the safety of generics and noted that the physician recommends generics for his own family. A social responsibility message tested the theory that injured workers would be willing to convert to generics to help control the rising cost of prescription drugs, even if they receive no direct monetary benefit from doing so. Both letters urged the injured workers to consult with their physician regarding their treatment. Both proved successful; however, the social responsibility letter was the statistically-significant winner. Injured workers who received it were 59.5% more likely to convert to a generic drug than those that did not receive a letter. The results of this study have provided tremendous insight and could potentially offer a new strategy for everyone involved in the management of a workers compensation claim. Express Scripts will continue to empower injured workers to make the best decisions regarding their medications. With this in mind, Express Scripts is building new communication programs to better engage injured workers in their own treatment. Included in this strategy is the expansion of this pilot into a full product, featuring the winning letter as its cornerstone. Express Scripts is committed to leveraging all of its assets clinical, safety and trend management programs and the work of the Research and New Solutions Lab to improve the safe and effective treatment of injured workers, while reducing drug spend for workers compensation clients. 5

6 Team Spotlight: Tim Pokorney, RPh, Clinical Director Tim Pokorney brings his background as a clinical pharmacist and his experience in workers compensation to his role as Clinical Director. In this position, Tim leads our team of clinical pharmacists dedicated to achieving and maintaining strong clinical results for our clients. Tim and his team provide extensive consultation to clients and analyze drug utilization trends for the Workers Compensation market. Tim oversees our suite of comprehensive clinical programs, including initiatives to address the abuse and/or misuse of narcotics. Now, more than ever, it is important for payers to aggressively manage cost and utilization, says Tim. My team and I are dedicated to helping clients minimize the risks of narcotic abuse and misuse. Our new solutions are already significantly contributing to the safety of injured workers, while curbing the rising costs for payers. Tim has worked for Express Scripts for seven years and in Workers Compensation for 5 of those years. During his tenure, his roles have afforded him experience in client contracting, account management, pharmacy operations and clinical services. He has led several speaking engagements for clients and the workers compensation marketplace. Tim earned his pharmacy degree from the St. Louis College of Pharmacy Express Scripts Holding Company. All Rights Reserved Let Express Scripts help you maximize your workers compensation pharmacy program. Call us at or us at

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