New Generic Approvals

The FDA recently issued several drug approvals for first-time generic medications. Some of these approvals impact workers’ comp populations, meaning that more cost-effective generics will soon be on the market to reduce drug spend on impacted claims.

Xeljanz® for Rheumatoid Arthritis

Xeljanz (tofacitinib) tablets were originally approved in 2012 and the product is indicated for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and polyarticular course juvenile idiopathic arthritis, a subset of juvenile idiopathic arthritis (JIA) in which more than four joints are affected during the first six months of illness.

In various industries, workers may develop certain forms of arthritis due to cumulative or acute trauma, or they may aggravate pre-existing forms of arthritis. This has led to an increase in specialty arthritis drugs making their way into workers’ comp, which is why drugs such as Xeljanz appear in claims.

Generic tofacitinib citrate tablets are now approved at 5 mg and 10 mg doses, though this generic approval does not apply to Xeljanz XR® extended relief tablets.

Aptiom® for Seizures

Aptiom (eslicarbazepine acetate) tablets were originally approved in 2013 and this product is indicated for the treatment of partial-onset seizures.

Many anticonvulsant drugs are relevant to workers’ comp, as they are often prescribed off-label for nerve pain. Furthermore, injured workers with traumatic brain injury (TBI) or other major head injuries may suffer from seizures. For these reasons, drugs such as Aptiom may appear in workers’ comp claims.

Generic eslicarbazepine acetate tablets are now approved at 200 mg, 400 mg, 600 mg, and 800 mg doses.

Brovana® for COPD

Brovana (arformoterol tartrate) inhalation solution was originally approved in 2006 and is indicated for long-term, twice daily administration for the maintenance of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

COPD can be considered an occupational illness for workers in certain industries or occupations, including miners, farm workers who are exposed to certain chemicals and pesticides, construction workers, sandblasters, and more.

Two generic approvals were granted for arfomoterol tartrate inhalation solution by the FDA – one from Axar Pharmaceuticals and one from Glenmark Pharmaceuticals.

Perforomist® for COPD

Perforomist (formoterol fumarate) inhalation solution was originally approved in 2001 for the maintenance treatment of bronchoconstriction in patients with COPD, including chronic bronchitis and emphysema.

Two generic approvals for formoterol fumarate inhalation solution were granted by the FDA – one from Teva Pharmaceuticals and one from Cipla Limited.

Tags: FDA, drug approval, generic, COPD, Perforomist, Brovana, seizure, Aptiom, Xeljanz, arthritis

In Claims Management, Centralized Data Means Empowered Decisions

This article was originally published by WorkCompWire. featuring Healthe’s Director of Product Management, Stephanie Arkelian, in their Leaders Speak forum.

The role of the claims professional is truly front and center. They are on the front line of claims management, and serve as the central point of communication between the injured worker and all other stakeholders.

I understand this well, not only from our conversations and research initiatives here at Healthesystems focusing on the claims professional experience, but because I used to be in that role.

Before I stepped into the role of product manager, developing solutions to meet today’s workers’ comp challenges, I was that adjuster out there trying to manage hundreds of claims. And I faced the very same challenges that I’m today focused on solving – challenges that these professionals are often still facing today. Working with disparate systems. Working with a multitude of vendors. Trying to coordinate all these services for the injured worker. It can become very complex and very confusing very quickly.

It is this front-and-center aspect of their role that positions claims professionals as key stakeholders in minimizing information gaps that can negatively affect patient outcomes. But only if they are empowered with the technology to effectively do so.

There are a lot of efficiencies to be gained using technology to streamline and simplify the process of managing an injured worker’s medical care. With the technology we have available today, it is possible for a claims examiner to view and manage activity for multiple ancillary medical products, services and vendors all in one place – whether it’s a referral for physical therapy services, or a ride to the doctor via Lyft. This visibility means that a claims examiner has a more complete picture of claims activity – and it’s a game changer.

Being able to centralize services minimizes gaps in coordination of care. Take the case where an injured worker is running late to a scheduled service, or transportation to an appointment is delayed. It’s critical to have insight into the bigger picture of all the moving pieces so that all the parties can be notified. The claims professional is empowered to properly manage that service disruption to potentially avoid a missed appointment, and any downstream issues that may come from that. In the short-term that may mean rescheduled appointments. In the long-term, disruptions to care can lead to bigger-picture consequences, such as delayed return-to-work or additional indemnity.

With this type of infrastructure in place, the sky is the limit in terms of what types of services and data streams can be connected. Imagine an experience where a prescription refill pattern identifies a candidate for a urine drug screen, and then automates a referral for this service based on pre-defined business rules. This type of automation helps efficiently connect the dots between claims risk and mitigative actions, while also freeing up the claims professional’s time to tackle other responsibilities.

Not only does easy access to complete information save time and money, it also avoids some of the added pitfalls of siloed systems, such as data inconsistency. For example, one system might use the “pay date” field for a transaction to indicate the date of payment receipt, whereas another system, or organization, might treat that same data field as the date they paid someone else.

It’s just one small example. But any time a single data field is being used to communicate two different things entirely, it can create upstream and downstream issues. If there is not awareness of the inconsistencies, issues will arise with reporting timeliness and cause communication challenges.

In addition to the gains that centralization can bring to the claims professional and claims process, there is also the injured worker to consider. Incomplete or incorrect information can delay care or cause claim stakeholders to reach conclusions that impact the patient in a negative way. In a best-case scenario, the injured worker becomes frustrated. In other cases, we may see this result in legal action.

Unfortunately, what we often see with a lack of access to timely information is a negative ripple effect. This is why the application of holistic insight and management across the multitude of workers’ comp services is key in managing the injured worker’s care.

Tags: Stephanie Arkelian, WorkCompWire, Leaders Speak

How Opioid Policy Impacts Opioid Utilization and Disability

The Workers’ Compensation Research Institute (WCRI) published a new report, Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability, which explores how policies limiting access to opioid prescriptions contributed to changes in opioid utilization and how they altered other medical care related to the management of pain.

The report is available for free for WCRI members, or available for purchase for non-members.

The study analyzes information for workers injured between October 1, 2009, and March 31, 2018, in 33 states, estimating the effects of state-level opioid policies by comparing outcomes in states that adopted such policies against states that did not, while accounting for other factors that could have influenced changes in opioid utilization and the other outcomes studied.

Overall opioid utilization has declined, with opioid utilization varying greatly between all claims and a subset of claims with seven or more days of lost work time.

From 2010-2018, claims with seven or more days of lost work time fell from a high of over 1,000 down to just over 200. Meanwhile, across all claims, MME hovered just over 200 in 2010 and fell to under 100 by 2018. In claims with more than seven days of lost work time, 50% had an opioid prescription in 2010, but that fell to 30% by 2018.

Prescription drug monitoring programs (PDMPs) led to a 12% decrease in the overall MME amount of opioids prescribed. Among injured workers who received opioids, PDMPs also reduced the likelihood that injured workers would stay on opioids long-term by 12%. Meanwhile, limits on initial opioid prescriptions resulted in a 19% decrease in the MME amount of opioids among claims with opioids.

Limited evidence found that workers increased the use of other types of care due to restricted opioid access. Relatively small changes were seen in the prescription for non-opioid pain medications, and for non-pharmacologic treatment, minor changes were seen in whether workers received active physical medicine services and the number of visits for those services.

There is some evidence that PDMPs led to substitutions from opioids towards other kinds of non-opioid pain prescriptions for certain injuries. This was seen in lacerations and contusions, as well as neurologic spine cases.

One interesting note is that neurological spine cases saw a 13% decrease in MME, along with a 14% increase in interventional pain management services, indicating that some substitution was practiced due to restricted opioid access.

PDMPs and limits on initial opioid prescriptions had little impact on the duration of temporary disability benefits captured at 12 months of injury.

Tags: WCRI, opioid policy, opioid access, PDMP, utilization

The Early Impact of COVID-19 on Workers’ Comp Claims

The Workers’ Compensation Research Institute (WCRI) issued a new report that examines the early impact of the COVID-19 pandemic on workers’ comp, focused on the timing and patterns of medical care delivery during the first two quarters of 2020.

This report looks at non-COVID-19 lost-time claims with injury dates in the first two quarters of 2019 (pre-pandemic) and 2020 (pandemic period) across 27 states, representing 68% of workers’ comp benefits paid in the United States.

Overall, the COVID-19 pandemic did not lead to any major delays in care. Claims with injury dates in the first two quarters of 2020 did not experience any noticeable delay in medical treatment when compared to the first two quarters of 2019. In fact, injury claims in Q2 of 2020 saw slightly shorter wait times or certain services, such as emergency room services, physical medicine, major surgery, and neurological/neuromuscular testing. And across injury type, fractures and lacerations had a slightly shorter wait time before emergency services in 2020.

One proposed reason for shorter wait times during the start of the pandemic is that the general public may have avoided medical services for non-serious medical concerns to avoid potential viral exposure. However, one area where time between injury and care increased was time between sprains/strains and major surgery.

On the subject of utilization, certain services saw decreased utilization, including:

  • Emergency room services, which dropped 4% in utilization overall
  • Major surgery, which decreased 3% in utilization
  • Pain management injections saw a 2% decline in utilization

However, in states greatly impacted at the start of the pandemic – Connecticut, Massachusetts, and New Jersey – greater decreases in utilization were seen:

  • Physical medicine and major radiology utilization fell 6%
  • Emergency room services fell 8%
  • Major surgery services fell 3%

Tags: WCRI, COVID-19, claim data

Clinical Minute Video Series

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