Can States Surpass Federal & Address Big Pharma?

Can States Surpass Federal & Address Big Pharma?

With some states and areas across the country on the receiving end of opioid painkiller prescription shipments that outnumber the people housed therein, state officials are beginning to address the link between the opioid crisis, Big Pharma, and the heavy burden weighing on their municipalities. In an attempt to hold Big Pharma accountable, they’re taking a page out of past lawsuits against tobacco companies – and suing them.

Key Players
Until now, these multibillion dollar companies have been sidelined in the fight against the opioid epidemic. Now they’re being looked at as star players by city, county, state, and federal officials – even the DEA has taken notice, responding in-kind. This year, in a push to hold opioid manufacturers and distributors responsible, multiple lawsuits have been launched…

States Join Forces in the Fight Against Opioids
Taking the lives of 40 Americans each day, the total economic burden of prescription opioid overdose is costing the country $78.5 billion per year – and these states are taking action…

  • Missouri
    Most recently, Missouri’s filed suit against 3 opioid manufacturers, alleging a deliberate campaign of fraud to convince doctors and the public against the highly-addictive, life-threatening potential of the drugs.
  • Mississippi
    Suing Purdue Pharma and 7 others, Mississippi lawsuits are borrowing tactics used in their successful fight against tobacco companies in 1998, alleging companies misrepresented the dangers of opioids to doctors and patients, marketing the drug as rarely addictive, and a safe substitute for non-addictive pain medications like ibuprofen or naproxen. But pharmacy companies don’t want the suit to go through – not until FDA-ordered studies on long-term risks/benefits are completed, which could take several years.
  • Ohio
    Ohio filed suit against multiple manufacturers for false advertising, Medicare fraud, and violation of the Ohio Corrupt Practices Act, claiming the companies knew (or should have known) their drugs weren’t safe or effective.
  • Illinois
    Illinois is taking part in multi-state investigations into manufacturers, with 2 lawsuits in-play. One against Insys, for the deceptive marketing of highly-addictive Subsys for the off-label treatment of back and neck pain in efforts to gain huge profits. Another, an anti-trust suit against the makers of Suboxone, used to treat opioid addiction, alleging a scheme to block generics to artificially inflate prices.
  • East Tennessee
    Prosecutors representing 9 counties are taking aim at Big Pharma using the Tennessee Drug Dealer Liability Act, or ‘crack tax’ law. Designed to hold dealers criminally and financially responsible for the effects of the drugs they distribute, the suit labels drug makers as dealers, further accusing them of lying about the addictive properties of opioids, aggressively pushing them as miracle cures for all types of pain. The state AG is investigating its options in pursuing its own legal action.
  • New York
    8 NY counties have joined in seeking compensation for expenses caused by the state’s growing drug problem, alleging marketing omitted critical information about the addictive nature of the drugs and risks associated with long-term use.
  • Everett, Washington
    They city of Everett filed suit against Purdue Pharma, makers of OxyContin, alleging the company was intimately aware its drug was being funneled into the black market, yet did nothing.

 

Distributors Sinking, Similar Challenges Against Manufacturers Possible 

CVS, Walgreens, Walmart, McKesson, Cardinal Health, KeySource, Sunrise Wholesale and more are facing charges and paying fines – sometimes multiple times. Some suits have settled. Others have resulted in criminal convictions. Could Big Pharma be next? Though manufacturers vigorously reject the argument they’ve fueled the current opioid crisis, it’s hard to ignore the overdose deaths – more than 300,000 since 1999. But opioids (opium, morphine, heroin) have been around, literally, for centuries, and their highly-addictive properties well-known.

More Lawsuits On the Way
Lawyers currently working these cases note a growing number of jurisdictions showing interest. States are joining forces in the current investigation, with dozens more lawsuits expected. The ultimate hope? That if enough attorneys general are able to join forces in bringing suits, they can accomplish what the federal government has been unable to… And snowball the lawsuits into a massive settlement that might finally put an end to practices that have fueled the deadliest drug overdose crisis in U.S. history.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ compensation insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Sources:

https://www.vox.com/policy-and-politics/2017/6/7/15724054/opioid-companies-epidemic-lawsuits

https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020/

https://www.levinlaw.com/government-opioid-lawsuit

https://www.washingtonpost.com/national/the-drug-industrys-answer-to-opioid-addiction-more-pills/2016/10/15/181a529c-8ae4-11e6-bff0-d53f592f176e_story.html?utm_term=.a364db6d5fe7

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How Does Doctor Shopping Impact The Opioid Epidemic?

How Does Doctor Shopping Impact The Opioid Epidemic?

Surprisingly, the non-medical prescription of drugs, including opioids, continues, with only states holding legislation against this dubious practice smothering the flames helping stoke the opioid addiction fire. Since 1999, deaths from prescription opioids have quadrupled, alongside opioid sales of painkillers such as oxycodone (Oxycontin) and hydrocodone (Vicodin). But this hasn’t stopped opioid abusing patients from trying to nab a couple of extra pills by ‘doctor shopping,’ the practice of hopping from physician to physician and playing the numbers until finding a doctor who will meet the patient’s desire for a few extra pills. Luckily states nationwide, alongside the insurance and healthcare community, are becoming increasingly aware of these issues, and are attempting to stem this contributing facet of the epidemic through the use of prescription drug monitoring programs (PDMPs). And a new study has shown them astonishingly successful.

An Easy-to-Use, Effective Means of Curbing ‘Doctor Shopping’

Physicians utilizing these state-run electronic prescription databases, mandatory in some states and voluntary in others, offers them access to each patients prescription history, and the opportunity to see drug types and quantities prescribed to patients before breaking out the prescription pad. In addition to thwarting potentially deadly drug interactions and excessive dosages, a recent study has shown that these programs are highly effective for reducing the non-medical prescription of drugs, boasting a whopping 80% reduction in the odds two (or more) doctors would dole out pain relievers for non-medical reasons to a single patient in states with mandatory PDMP use, and slashing the odds 56% in states with voluntary participation. Every state except Missouri now has one of these programs. Other studies have also shown states tracking a wider range of potentially addictive medications and updating databases weekly witnessed the biggest reduction in overdose deaths.

Won’t Patients Turn to Illicit Substances?

Public health advocates have had this worry for quite some time, but the current study pointing to the massive, 80% reduction in non-medical prescription of opioids in those states with mandatory programs also uncovered some reassuring news. PDMPs did not, in fact, lead to an increase in doctor shopping individuals turning to heroin. This offers hope for the promise of PDMPs as part-and-parcel of a multifaceted, comprehensive strategy toward fighting the nation’s opioid epidemic, which steals the lives of 91 Americans each day.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/how-does-doctor-shopping-impact-the-opioid-epidemic/

The ER and Opioids

A common thread has been found in opioid addiction, winding its way from the ER and into homes across the nation. Beginning as a single prescription for a minor issue or unexpected injury, ER physicians are inadvertently rolling the dice and chancing long-term addiction in their quest to simply relieve pain, when there could be better alternatives.

How Commonly are Opioids Tossed-Out in the ER?

Medical researchers studied hundreds of thousands of Medicare-paid ER admissions nationwide, and uncovered a surprising trend in standard approaches to treating pain. Within the same facility, patients discharged with opioid scripts ranged from 7% on the miserly end, to 24% with heavy-handed prescribers. A wide difference in pain management, with similarly disparate results: Patients, who by the luck of the draw were seen by heavy-handed prescribers, were found 30% more likely to become long-term users.

Do Prescription Strength & Amount Play a Role?

A broad variation was also seen in strength and amount, with some physicians prescribing half the dose as others, and showing similar results: A 30% greater chance of long-term use with high-dosages, versus cautious prescription.

Who Was More Likely to Return to the Hospital?

No evidence was found of patients of low-prescribing physicians returning for handout. High prescribers, on the other hand, saw an increase in returning patients suffering opioid-related complications ranging from falls and broken bones to overdoses.

Why the Seemingly Haphazard Prescription?

Because pain treatment is largely improvisational, and often a result of learning by example during observational years, the major issue appears to be lack of protocol and best practices. Where these do not exist, physician adherence to guidelines is poor. Sadly, the reliance on these informal treatment procedures puts public health at risk.

How Can We Empower Physicians and Protect Patients in Need of Relief?

In order to address this epidemic and its deleterious health and financial effects, a collaborative approach is essential, however the doctor’s role is pivotal to keeping excessive prescribing in-check while still managing the pain of those most in need. Broad spectrum and individualized strategies, those that are scientifically-backed and with a reputation for efficacy, are essential to improving patient outcomes without opioids. Even more pivotal, however, are honest, face-to-face discussions between healthcare providers and the industry, be it the FDA or insurance regime, imparting such wisdom to physicians to the benefit of the patient. Post-treatment observation and evaluation must be ongoing, to ensure successful, appropriate treatment and full recovery. And this proven, team-based approach exists with ANS Solutions Pharmacotherapy Review. Won’t you follow the path to a brighter future? Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/the-er-and-opioids/

The Impact of Workers Compensation Compounding

As custom-made compound prescriptions concoctions continue to rack-up higher workers’ compensation costs, insurers are scrambling to find alternatives and employers are looking for relief from equally inflated premiums. With little to no evidence as to the efficacy of such creations, many states have implemented treatment guidelines directing doctors to more evidentiary-based, easily reimbursable options. Despite guidelines and formularies however, loopholes in coverage continue to allow providers to sell millions of dollars of compounds, with many companies submitting inflated reimbursement bills in their attempts to get paid.

A Growing Issue in Workers Compensation

This June, the U.S. Attorney’s Office brought criminal charges against such providers across the country, accusing them of defrauding the Medicare, Medicaid, and Tricare health insurance programs that serve the military and their families. Additionally, the Inspector General of the U.S. Postal Service identified compound drugs as attributable for 34% of the postal service’s prescriptions, and 53% of prescription drug costs in 2015, a rise from 22% and 27% in 2014, respectively. State and federal prosecutors also continue to finger some pharmacies for offering doctor kickbacks in exchange for prescriptions.

Money or medicine?

Industry guidelines point to the use of such compounds as a last resort, accepted in instances where a person is allergic to an ingredient in a drug, or when a liquid version of a commercially available drug is necessary for one who cannot swallow capsules. Some doctors prescribe initially despite these guidelines. The unnecessary prescription of compounds is costing the workers’ comp industry billions annually.

Deep impact

2015 calculations indicate…

  • Re-packaged drugs dispensed by physicians cost employers 60% to 300% more than those dispensed at retail pharmacies.
  • The average paid per compound drug increased by more than two-thirds from $460.00 to $774.00, though non-compound drugs fell slightly from $113.00 to $108.00.
  • The U.S. Postal Service alone spent a whopping $390,000.00 a day for compound drugs in 2015.

Tired of paying more for ineffective treatments?
Proven, more affordable, clinically tested and approved options to compounds do exist. It’s time to find a better way. Discover how to achieve better claims outcomes with ANS Solutions Pharmacotherapy Review. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/the-impact-of-workers-compensation-compounding/

Why ANS Pharmacotherapy Review is so Effective

The prescription pain medication crisis is taking its toll across the U.S. Costs are extreme, with a broad array of collateral damage fanning out from those effected to families and industries, among the hardest hit, workman’s comp. So extreme are the effects of addictive and deadly prescription opioids, even the Federal Government has taken notice, with the CDC stepping in to release new opioid prescribing best practices earlier this year in hopes of ushering in a new era for an ailing nation. The issue is out in the open. Are you missing out on the opportunity to protect patients and break the pharmaceutical cost cycle with a lackluster pharmaceutical intervention program?

Not all drug utilization review programs are created equal

Traditional pharmaceutical intervention programs often yield poor results. Why? Insufficient “drug evaluations” yield sub-optimal analyses, neglecting to account for patient and prescriber history, co-morbidities, and other important factors. Peer-to-peer, phone-based approaches questioning treatment efficacies have the tendency to put doctors on the defensive or induce feelings of frustration over micro-management. Non-binding, verbal commitments lead to repeated calls regarding the implementation of reduced treatment protocols, and ultimately future “call-dodging.” Settlement dates are then repeatedly pushed out, with poor clinical outcomes resulting.

ANS’s proprietary Pharmacotherapy Review

Pharmacotherapy review processes built on the foundation of the intelligent and intimate collaboration of all vested parties produces superior results. How does ANS’s Pharmacotherapy Review fix what’s broken in the typical pharma intervention system?

  • In-depth, in-person collaborations.
    In-office visits with legal nurse experts featuring evidence-based, patient-centered treatment plans presented in a non-threatening manner increase openness to alternative therapies.
  • Clear guidelines.
    Written, signed, collaborative agreements are established within 4-5 weeks, complete with detailed drug utilization changes curtailing costly pharma regimes, keeping all parties accountable and on the same page.
  • Patient-centered care.
    Physician-directed care with the interest of the injured patient in-mind, including expert consultation, thorough review of medical history and prescription data, and clinically-proven drug alternatives reduce Payer costs and improve patient quality of life, decreasing the potential for drug related issues such as drug interactions and overdose.
  • Friendly follow-ups.
    Doctors work with a dedicated CLO (Clinical Liason Officer) until settlement. Repetition of visits with an established legal nurse builds better relationships, allowing for amiable quarterly follow-ups regarding compliance and treatment evaluations, ensuring proper dosing modifications or weaning of medications.
  • Quantifiable impact (& performance guarantee).
    The hard work accomplished by ANS representatives and collaborating parties is seen in post-meeting reporting, showing enhanced clinical and patient outcomes as well as reduced pharmaceutical treatment costs. In fact, ANS proprietary Pharmacotherapy Review program boasts:

    • A success ratio of 94% of all case referrals.
    • Enhanced clinical/patient outcomes.
    • Acceleration of MSA settlements.
    • Average cost reductions of over 25%.
    • Loss ratio reductions from 1-2%.
    • Average first year savings of over $7,000.
    • Average life expectancy savings of greater than $250,000.
    • An average return on investment of 20 to 1.

Tired of using the same procedures and expecting a different outcome?
You won’t get extraordinary results with the average pharmaceutical intervention programs. Redefine success with the help of ANS Solutions Pharmacotherapy Review.

Contact http://www.ans-solutions.com today.

 

Original content posted on http://ans-solutions.com/why-ans-pharmacotherapy-review-is-so-effective/

Patient Engagement Encouraged through Prescription Drug Label Enhancements

Upcoming improvements to prescription drug labeling are hoped to positively affect patient care across the board. Intentionally kept in the dark on the ingredients and indications of prescription drugs for well-over 100 years, the healthcare industry is shifting from the past’s blind trust to finally realizing today’s modern paradigm: Engaging patients as active participants in their own healthcare endeavors.

Small Label, Big Impact
Improving the synchronization between in-office care and home care, the FDA’s latest labeling procedures will not only help patients under a physician’s care better understand why each medication is being prescribed, clearly listing indications on each prescription drug product’s label, but offer a vast array of opportunities for the betterment of treatment regimes, helping…
In the understanding of prescription regimens and scheduling.

  • Verify each prescription is effective/providing benefits for its intended purpose.
  • Reduce confusion following brief or rushed clinic encounters.
  • Make the identification of drugs easier to allow for proper use/best practices.
  • Reduce the incidence of over-prescription, duplicate or unnecessary medications.
  • Keep not only patients, but caregivers, pharmacists, and other treating physicians in-the-know on conditions being treated and desired outcomes.
  • Improve safety by reducing prescription or dispensing errors.

The Missing Link
This added information, “knowledge” (dubbed the “sixth” patient right in a recent publication of The New England Journal of Medicine), is bringing to light details which have previously fallen through the cracks in today’s modern world of typically rushed, commonly overcomplicated healthcare regimens. Information critical to the patient’s understanding of why a medication has been prescribed and for what conditions or purposes, allowing for a clearer assessment of efficacy for all involved parties.

Are You Living In The Dark?
At ANS Solutions, we also understand the benefits of synchronicity in patient care. The role this plays in in treatment progression, effectiveness, and quality of life from the treatment of routine health issues to return-to-work programs for injured workers is second-to-none. That’s why our industry standard pharmacotherapy review program focuses on face-to-face collaborative care, built upon the integrative collaboration of all effected parties, from the injured worker to our skilled nurse experts and treating physicians, allowing us to produce the very best outcomes in the business with the latest in clinically-proven treatment regimens.
Healthcare costs and injured workers ailing? Uncover a new era in workers’ comp treatment. Contact http://www.ans-solutions.com today.

Sources:

 Original content posted on http://ans-solutions.com/patient-engagement-encouraged-through-prescription-drug-label-enhancements/

Innovating Clinical Intervention

The lack of communication among treating physicians for injured workers has been a known deficit in large loss claims for some time. Professional liability insurance companies have recently issued statements concerning the trend of incomplete patient information, missing tests and poor communication among physicians resulting in lengthier recoveries and costly medical treatment regimens.

Medical Legal Nurse Consultants at ANS SolutionsCurrent clinical intervention programs embraced by the industry merely scratch the surface of success as they focus solely on a patient’s medication therapy. The reality is that in today’s landscape of multiple doctors and pharmacies, shortened appointments, and conflicting priorities, not all prescribers have the time to conduct an extensive review of a patient’s medical history. Critical factors that can change the trajectory of a claim may be missed such as:

  • lab and diagnostic results;
  • additional therapies may not have been tried;
  • inconsistency in diagnosis between doctors and;
  • high risk patient behavior could be present

Optimized Treatment Outcomes through Pharmacotherapy Review

Missed intervention opportunities such as those listed above result in a less than optimal treatment outcome and are often costly. Through the advanced clinical analytical capabilities of ANS nurse experts, our Pharmacotherapy Review program removes the blindfold and brings to light the patient’s full medical history and contributing health factors. The result delivers a complete view of the patient that informs accurate and impactful care decisions. Safety concerns most often uncovered include:

  • Duplication of therapy
  • Drug-Disease Interactions
  • Lack of evidence for use of current treatment therapies
  • High dose of medication(s)
  • High incidence of side-effects
  • Excessive duration of therapy
  • Patient age concerns

Our unique Pharmacotherapy Review program provides a holistic clinical assessment to deliver informed and extremely detailed patient recommendations. Recommendations that benefit the outcome of large loss workers compensation claims for the injured worker and the payer alike. To find out more about our medical cost containment strategies contact us today at http://www.ans-solutions.com.

 

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