By Frank Lewis
The specter of the over-prescribing of opiates, much of which centered around Scioto County, and other parts of southern Ohio, continues to cause ripples in the stream of the state’s drug problems. Ohio Bureau of Workers’ Compensation (BWC) Board of Directors heard a presentation this week highlighting the result of changes made to its pharmacy management program in recent years, including a reduction in prescriptions of some of the most commonly overused drugs, and total drug cost savings of more than $20 million since 2011.
The pharmacy program changes were introduced following direction from Gov. John Kasich to focus on improving injured worker care while finding ways to reduce prescription drug abuse.
“While prescription narcotics can be a legitimate part of treatment, we have a duty to protect injured workers and their households from potential abuse by ensuring narcotics are properly prescribed and monitored,” BWC Administrator/CEO Steve Buehrer said. “By prescribing only the right medicine, at the right time, for the right duration, we are improving care, getting the worker healed and back on the job sooner, and ensuring that medicine cabinets aren’t stocked with potentially dangerous drugs that could lead to overdose or addiction.”
That issue hit home in Portsmouth, when the Tenth Appellate District Court upheld a Franklin County Common Pleas Court ruling allowing the permanent revocation of Dr. James Lundeen’s license to practice medicine in Ohio to stand. Investigators from the Attorney General’s Office, Bureau of Workers Compensation, the State Highway Patrol and other agencies raided Lundeen’s offices in downtown Portsmouth and Plymouth in March 2011. The State Medical Board suspended Lundeen’s medical license based on the finding that Lundeen’s continued practice “presented a danger to the public.” Lundeen had argued that the BWC went after him for questioning some of their practices.
Opiate doses have dropped by 10.9 million since 2010, before the introduction of BWC’s first-ever outpatient medication formulary in 2011. The changes also resulted in a 27.8-percent drop in opioid prescriptions and a 72.9-percent decrease in skeletal muscle relaxant prescriptions in 2013 compared to 2010.
The formulary is updated regularly and includes guidelines for coverage of various drugs. For example, a 2012 update restricted most skeletal muscle relaxants to coverage for 90 days from the first prescription, plus one additional 30-day prescription per 12-month period. Some restrictions put into place for opioid and anti-ulcer agents require prior authorization or a related condition approved in the claim.
The announcement comes on the heels of a new rule requiring medical providers caring for chronically injured workers to use the Ohio Automated Rx (prescription) Reporting System (OARRS). BWC’s newest pharmacy rule, similar to recently adopted statewide Opioid Prescribing Guidelines, became effective Jan 1. Ohio providers who write controlled substance prescriptions for chronic care must now enroll in OARRS in order for BWC to cover these prescriptions. Chronic care is when providers write three or more prescriptions for controlled substances for the same injured worker during a 12-week period.
“This revision to our rule supports the bureau’s goal to provide appropriate medications to our injured workers in a safe and efficacious manner,” Pharmacy Programs Director John Hanna, who delivered the presentation during the board’s Medical Services and Safety Committee meeting Thursday, said. “We want our prescribers to take every available step to prevent the risk of an injured worker accidentally overdosing on his or her medication. Checking the OARRS database is an excellent preventive measure.”
Other pharmacy program controls BWC implemented to support prescription drug safety for injured workers include a lock-in program that limits the practice of doctor and pharmacy shopping; Standardized Drug Utilization Reviews that objectively evaluate the necessity and appropriateness of prescription drug treatment and identify overuse or danger; generic medications which are required when available; and point of service edits that allow for prescriptions that aren’t related to injured worker claims to be screened out to ensure injured workers receive medications relevant to their injuries.
“We will keep refining our efforts to protect injured workers as if they were members of our own families,” Buehrer said. “Our goal is to assist in their recovery, not hinder it.”
Frank Lewis can be reached at 740-353-3101, Ext. 252, or on Twitter @FrankLewispdt.