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


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Medical Marijuana Vs. Big Pharma

Medical Marijuana Vs. Big Pharma

Increasingly gaining ground as an accepted medicine by top health associations, researchers, and medical journals, the marijuana industry continues its massive expansion, with legalization encompassing more than half the U.S. Predicted to expand nationwide by 2021 by investment firm The Motley Fool, other sectors of the economy are feeling the strain of the industry’s new growth – but no one greater than Big Pharma.

Marijuana & Pharmaceutical Market Share
In an effort to determine how cannabis cash flow is effecting the pharmaceutical industry, researchers at the University of Georgia uncovered just how much of the pharmaceutical pie is being gobbled-up in medical marijuana states – and the results were stark: The average doctor in cannabis-friendly states prescribed 265 fewer dosages of antidepressants, 486 less anti-seizure meds, 541 fewer anti-nausea doses, 562 less anti-anxiety meds, and a whopping 1,826 less doses of pain medications, saving the government’s Medicare Part-D program an estimated $165 million on prescription pills. Taking that total nationwide, an estimated $470 million would disappear from Big Pharma’s annual revenue from this avenue alone.

Expanding Data on Marijuana & Opioids Worrisome for Pharma
A 2014 JAMA study stated opiate overdoses dropped roughly 25% in states with legalized medical marijuana, implying patients may be using it for pain treatment – or to lessen their painkiller load. According to according to the report in Drug and Alcohol Dependence, legalization states also failed to see the expected influx of pot smokers through hospital doors – instead experiencing a decline in hospitalization rates for opioid abuse and overdoses, which dropped 23% and 13% respectively, on average.

Fighting Legalization While Simultaneously Developing Synthetic Cannabis Drugs
This big dip in pharmaceutical purchases is hitting Big Pharma hard, and combined with industry interests, is fueling massive donations to anti-marijuana campaigns, making Purdue Pharma (OxyContin) and Abbot Laboratories (Vicodin) some of the largest contributors to the Anti-Drug Coalition of America. Now infamous, Insys Therapeutics, Inc. (Fentanyl), who currently faces multiple federal and state investigations for aggressive sales and marketing practices, donated $500,000 to Arizonans for Responsible Drug Policy, helping eke out a narrow 51-49 block of Arizona’s 2016 legalization attempt, and making it the only state in which legalization failed in 2016 voting. One of the largest individual contributions to any anti-legalization campaign in history, just five months later Insys won approval for a cannabis-derived pharmaceutical – an anti-nausea drug for AIDS patients – causing cannabis market leaders to reflect on the ethics of Big Pharma’s positioning, and why it has been favored by the DEA and FDA over plants that have already proven effective, safer, and cheaper than prescription drugs.

Stacking the Deck
Few have the resources necessary for this level of lobbying, or to manage the massive fees and extensive oversight necessary to work with the DEA and FDA for testing marijuana usage and product development – but Big Pharma does. It has achieved approval for other drugs in the past, including synthetic THC med Marinol for cancer and AIDS patients. Two cannabis-infused chewing gums by AXIM Biotech now currently await approval for IBS and MS treatment, as well as a topical for eczema/psoriasis. Kannalife Sciences is also developing new drugs for degenerative brain conditions (hepatic/chronic traumatic encephalopathy). Once approved, the drugs are classified separately from Schedule I whole plant marijuana products, their kissing cannabis cousins, and 100% legal with a script.

Are You Ready for a Changing of the Tides?
The workers compensation world is sure to experience turmoil over the upcoming years as changing legislation and front runners in the marketplace scramble for their share of the pie.

anthonyAbout 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. 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 visit .

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Medical Marijuana and the Workers Compensation Conundrum – Part 1

Medical Marijuana and the Workers Compensation Conundrum – Part 1

Because the U.S. Federal Government has dug-in its feet, leaving marijuana as an illegal, Schedule I drug under the Controlled Substances Act, state governments have been left to individually pave their own legalization paths, leaving a frustrated public in the wake. Employers, employees, doctors, workers comp case managers, and more feel frustratingly in-the-dark as ever-diversified, continually evolving legislation continues to change the landscape. This is the first post of our two part series of spotlighting medical marijuana in the marketplace.

What We Do Know About Medical Marijuana

Though state laws vary widely on the amount of legal possession and personal cultivation for medical use, to-date 29 states and D.C. have legalized marijuana for medical use, including 8 states who’ve legalized its use recreationally. For medicinal purposes, marijuana has been scientifically confirmed effective for pain relief, appetite stimulation, nausea control, and reducing ocular pressure. It is arguably cheaper and less addictive than opioids, however both research and quality control are lacking. For injured workers and those in the workers’ comp industry, its most-likely application is pain relief, however it’s typically not be the first drug in the treatment lineup for prescribing physicians.

What’s Murky About Medical Marijuana and Workers’ Compensation

Marijuana dispensing differs from run-of-the-mill pharmaceuticals, with product obtained from dispensaries or home growth, not pharmacies, leading to a gap in patient information on potentially dangerous drug interactions. Patient protections also remain muddy. Still illegal under federal law, stateside court rulings are chaotic. Fifteen states offer little to no employee protection, while 11 states explicitly provide protections from retaliatory actions to limits on drug testing from employers. Furthermore, all states with medical marijuana have pending legislation and litigation that could have a broad impact on the workplace, creating a landscape reminiscent of the Wild West.

Who’s Paying For Medical Marijuana Prescriptions?

Who knows? Medical marijuana’s Schedule I status prohibits its inclusion in the National Drug Code, leaving Medicaid and Medicare patients on the sidelines. This lack of regulation also equates to a dearth of coding, complicating processing for pharmacy benefits managers. And state-by-state case law for prescription coverage from employer-sponsored coverage to workers’ comp, like employee protection legislation, also varies widely.

Who’s Got a Headache?

Employers. Though there is federal protection backing drug-free workplace policies, including “zero-tolerance” for specific jobs such as heavy equipment operators, pilots, and surgeons, ever-changing legislation makes it difficult for employers to figure out which end is up. In the meantime, knowledge of state-specific legislation remains key to compliance, with an attitude of managing medical marijuana like any other powerful legal prescription drug that could impair mental capacity a logical choice: Accommodate the needs of injured workers – but uphold a safe work environment, as always. ANS Solutions Medical Cost Containment Programs are the only end to end pharmaceutical cost containment programs in the industry that genuinely put the patient first, while minimizing the cost of settlement in large loss workers’ comp claims.


ASansAbout 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. 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

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The Position of Workers Compensation in 2017

With the election of a new president who is ushering in a new era for the government, the trickle-down effect to the workers’ compensation industry just might sweep you off your feet. Prepare yourself with the industry knowledge you need, and avoid being overtaken by the tsunami…

The 2017 Workers’ Compensation Industry Issues to Watch:

  • The Affordable Care Act (ACA)
    Like a rogue wave, changes to the ACA may pop-up with little notice. These changes will influence the industry, including claims frequency, claims shifting, and cost shifting if/when private insurance is lost by injured workers, potentially shifting the industry back into the role of “medical insurance for the uninsured.” Preparing for engagement and rapid response to proposed legislation will remain integral as ACA changes are ironed-out in the coming year.
  • Nationwide Physician Shortages
    America is projected to be short an estimated 12,000 to 31,000 primary care physicians by 2025, according to the Association of American Medical Colleges. Surgeons are also expected to be in short supply. Though effects will vary based on geographic location, coupled with population growth, the aging Baby Boom population, Affordable Care Act instability, and the nationwide opioid crisis, this single phenomena could converge in a myriad of issues within the workers comp industry.
  • Changes to the Workforce
    As the economic current in the U.S. changes, the manufacturing industry may re-emerge, detracting from what is currently a service-based economy. The mobile workforce will also continue to evolve, such as remote and telecommuting positions. Workforce changes aren’t simply labor-related, however, the aging American workforce across the country will also play a large role.
  • Prescription Drug Abuse
    The overuse and abuse of prescriptions drugs, particularly opioids, continues to be a turbulent issue in the industry, driving workers’ comp costs and leaving opposing forces facing-off at a line in the sand. As federal and state lawmakers continue to bandage this issue across the medical industry, claims management teams and attorneys will need to move forward in addressing this issue in claims, monitoring prescriptions, recommending “drug contracts,” and better engaging with physicians regarding the risks of abuse, where permitted. On the flipside of the drug abuse coin, the consequences of injured workers medical marijuana scripts influencing on-the-job risks will continue to be a sticky wicket.
  • Profit & Loss Scenarios
    Though the workers’ comp industry saw their first underwriting profits in 2013, the trend is not expected to continue. Falling rates and increasing exposures, particularly over the long term, point to a negative outlook overall, with combined ratios of 100% projected for the coming year. Medical providers still continue to increase reimbursement rates to offset costs from lackluster Medicare and Medicaid payments, and medical and pharmaceutical advancements increase the risk of loss. Maintaining proper reserves, conducting timely settlement reviews, and utilizing appropriate resources over the course of the year will be key.

Make Progress in Managing Risks & Costs
No matter how fast the tide rushes in, ground yourself in facing this year’s obstacles with positive change, putting yourself in the best position to avoid being washed out in the chaos. With the transparent, mutually beneficial workers compensation cost containment services of ANS Solutions and our medical cost containment strategies, you can support both financial savings and positive outcomes, with a program that actively engages workers compensation patients with a positive experience, gaining unmatched results via true, face-to-face interactions between all involved parties for a complete team approach to care. Ride the wave of the future, contact today.


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Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

  • Evzio (2014)
    The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
  • Narcan (2016)
    A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at today.


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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 today.

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What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

  • A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
    • Higher average costs per indemnity for workers over 30.
    • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
  • Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
    • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
    • 2003-2004: Drop in claim severity (reform laws enacted during this time).
    • 2003-2008: Indemnity claim frequency declines dramatically.
  • Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
  • Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
  • Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

  • Consolidation and coordination of drug therapies between multiple prescribers.
  • Consideration of alternate therapies.
  • Specification of weaning programs for over-prescribed narcotics.
  • Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact today.

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