Drug Utilization Review: Process Targets Prescription Drug Misuse
February 4, 2013
In May 2011, Ohio Governor John Kasich signed into law a bill focused on pain management clinics. Some clinics had been referred to as “pill mills” and were targeted by health officials for contributing to prescription drug misuse and overdose deaths in Ohio.
In coordination with the Governor’s actions, the Ohio Bureau of Workers’ Compensation (BWC) also took steps to help curtail and eliminate prescription drug abuse within Ohio’s workers’ compensation system. BWC’s strategy included formulary changes and working closely with their pharmacy benefits vendor to screen prescriptions unrelated to a claim and ensure drug relevancy in the treatment of Ohio’s injured workers.
Effective January 2012, BWC began allowing Ohio Workers’ Compensation managed care organizations (MCOs) to initiate the Drug Utilization Review (DUR) process. This partnership allows MCOs to review injured worker medications, potentially recognize dangerous dosages or combinations and identify overutilization or inappropriate medications being paid in a claim. BWC’s pharmacy staff also implemented bi-weekly conference calls with MCOs to help identify problem providers and other issues related to narcotics and prescription medications.
CareWorks has conducted drug reviews since 2006, clinically reviewing claims for potential narcotic abuse, appraising if medications are related to a claim and identifying multiple prescribers. CareWorks’ nurses and medical case specialists review pharmacy reports to ensure medications, dosages and costs are appropriate for the type and severity of an injury. CareWorks ensures a response to the DUR and monitors medication payments when payment has been denied in a claim.
In a recent CareWorks report of workers’ compensation claims with dates of injury from January 1, 2008, through August 31, 2012, prescribed medications used to treat injured workers represented three percent of total medical costs. While representing only a small fraction of overall medical service costs for a claim, the health and addiction dangers of inappropriate pharmaceutical care can negatively impact an injured worker’s recovery and ability to return to work, which in turn can impact their family and their employer.
It’s important for Ohio’s workers’ compensation community to continue working together to find and eliminate prescription drug misuse and abuse which can harm patients and the system.
If you’d like to learn more about CareWorks’ DUR process, please call us at 1-888-627-7586 and ask to speak to your individually assigned CareWorks Account Executive. Or, send us an email at firstname.lastname@example.org.
Thank you for continuing to support CareWorks as your workers’ compensation managed care organization (MCO). We look forward to sharing more news and information to help you best manage your workplace injuries and promote healthy lifestyles for your valuable employees.