November 17, 2021
Why watching prescriptions closely is so important
It’s not hard to find a story on prescription drugs in the headlines.
Maybe you’ve seen news reports on topics such as:
- Prescription drug abuse, which has reached epidemic proportions
- Arguments of overmedication and the push for non-pharmaceutical or non-narcotic alternatives
- Lack of affordability, with pricing increases far outpacing inflation
All of these issues and many more can come into play when prescription drugs are needed to treat work injuries.
That’s why SFM works hard to make sure injured employees’ medications are managed well. As part of that effort, we partner with pharmacy benefits manager, myMatrixx .
myMatrixx negotiates pricing for prescription drugs and monitors whether comparable, lower-cost drugs might be available, but its services go beyond cost savings. SFM and myMatrixx work together to see that injured employees are getting the best prescription drug treatments for their injuries, and aren’t being put at risk for addiction or dangerous interactions.
The safety of our injured employees is critical.
As pharmacy benefits manager, myMatrixx acts as an intermediary between SFM and pharmacies, negotiating and paying for medications needed to treat work injuries and connecting the appropriate claims representative or nurse case manager when the medications require approval.
myMatrixx has pharmacists on staff who work together with SFM’s prescription drug clinical review nurse, nurse case managers and physician consultants.
How does SFM ensure injured workers are getting safe and effective prescription medications?
myMatrixx provides SFM with reports that give us the opportunity to monitor injured employees' prescriptions. This allows us to address dangerous combinations of drugs, prescriptions that are higher or lower than recommended doses of medications, and ineffective treatments for injuries.
For example, in one case an employee complained that his prescription drug wasn’t helping him. SFM’s prescription drug clinical review nurse then discovered he wasn’t taking a high enough dosage for it to work.
If there is any concern about a drug, SFM’s nurses or one of our physicians can speak directly with an employee's doctor. Optimal, safe and appropriate medication management is our goal.
How do SFM and myMatrixx control prescription drug costs?
In the U.S., prescription drug pricing has been increasing sharply — at a rate of around 10 percent annually for the past three years, according to a recent Kaiser Family Foundation article which analyzed data from the Centers for Medicare and Medicaid Services .
Prescription drug spending now amounts to 9.2 percent of national health spending, according to the Centers for Disease Control and Prevention.
Costs for individual drugs can vary greatly, sometimes for no obvious reason. Here are a few recent examples of surprising variations in prescription drug pricing:
- One pill that combines two drugs costs 10 times more than they would cost if purchased individually
- A 500 mg tablet of one drug costs 7 cents, while a 1,000 mg tablet of the same drug costs $8 , or over 5,600 percent more per milligram
- The price of one drug increases 5,000 percent overnight
The world of prescription drug pricing can be complicated at best and downright baffling at worst.
This is why working with a pharmacy benefits manager is so important.
myMatrixx negotiates with its network of 65,000 pharmacies on drug pricing and monitors prescriptions to identify whether identical or comparable drugs might be available at lower prices.
What is SFM doing to prevent opioid addiction?
One major reason prescription drugs have been getting so much attention recently is the sharp increase in prescription painkiller addiction.
According to the CDC , “opioid prescribing continues to fuel the epidemic” of drug overdose deaths.
As many as 1 in 4 people who receive prescription opioids long-term for non-cancer pain in primary care settings struggles with addiction, according to the CDC.
SFM hired Prescription Drug Clinical Review Nurse Gail Pravatiner in 2015 to help prevent addictions and advocate for weaning patients off the drugs, or at least getting them to a safer dosage.
She sends letters to treating physicians of injured employees who’ve been prescribed high doses of opioid painkillers asking them to develop plans to wean the patients off of the drugs. With increased awareness of the dangers of opioid use disorder or addiction, more and more doctors are complying. New, strict rules on prescribing opioids for long-term use in states including Minnesota and Wisconsin have also helped. In addition to state rules, the CDC issued opioid prescribing guidelines in March of 2016.
In some cases, injured employees themselves request to be weaned off the drugs due to safety concerns after seeing the letters, Pravatiner said.
We consider it our responsibility to injured employees and society as a whole to do our part to prevent opioid addiction.
~ Ceil Jung, SFM Director of Medical Services
Sometimes, simply tapering down the medication over time isn’t a safe option. In cases of long-term, high-dose opioid use, other dangerous drug combinations, or both, SFM has sent injured employees to rehabilitation programs. These programs focus on non-medication pain management treatment as they help people stop using their opioid painkillers.
Overall, SFM has been successful in helping 40 percent of injured employees taking opioids discontinue use, and has seen a 90 percent decrease in employees taking more than 120 milligrams morphine equivalent dosage (MED) from 2015 to present.
“We consider it our responsibility to injured employees and society as a whole to do our part to prevent opioid addiction,” said SFM Director of Medical Services Ceil Jung. “It’s been gratifying to see injured workers get their lives back as a result.”