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Workers' Compensation Blog

Are They Going to Stop My Pain Medicine?

Thursday, February 21, 2019

Current State of Affairs:

It is not a secret that there is an opioid crisis in this country. In recent months there has been a push by government to help cure this crisis. There are reports that pharmacies are in short supply of many opioid medications, and many doctors have refused to prescribe them at all anymore for fear of losing their medical license. There is no question that something has to be done, but the hope is that potential regulations and government referendums enact a holistic response to this epidemic. Sufferers need alternatives to pain pills and support to wean down from the addictive medicines.

Workers' Compensation and the Opioid Epidemic:

To an injured worker with extreme pain due to an accidental injury or an occupational disease the news can seem terrifying. Federal and state regulations seem to have taken an extreme attitude while examining doctors and dispensing pharmacies under a microscope. While regulations will have a beneficial impact on helping the crisis, the process in getting there may create greater hardship along the way. Many workers' compensation claimants do not know where to turn and are just waiting in fear that their medications will be cut off. Some insurance companies have stepped up and taken the problem head on. They have reviewed their client base and flagged those cases where the opioid level is very high and offered many kinds of treatment options to help a client manage their pain regimen.

However, other insurance companies are trying to cut medication doses that are not dangerously high and do not offer to pay for alternative treatments under the ‘guise' of helping the claimant get off their medications because they ‘care'. I have been in court too many times with issues of weaning off opioids, for the good of the claimant, and the insurance company is refusing to pay for alternative pain treatments or medications that are beneficial. This tactic goes against the very purpose that workers' compensation laws were enacted, but there is hope. The Workers' Compensation Commission understands that many injured workers' have severe injuries and will likely need to continue opioid use in lower dosages and will order alternative treatments and weaning programs in the appropriate circumstances.

What Should I Do if I am on Opioids?

The focus of late is to wean down not wean off and this should let injured workers' breathe a sigh of relief. Stopping narcotic medication ‘cold turkey' can cause grave implications on patients' organs as well as negative psychiatric effects due to the rapid increase in pain levels and withdrawal symptoms. Therefore, it is important to either participate in a proper weaning program or to work with your doctor to devise a safe and effective treatment plan. Without the proper support in place reducing these medications may feel impossible. The Center for Disease Control (CDC) categorizes a morphine equivalent dosage of opioids over 90mg as high and the recommendation is to wean down below 90mg.

The Workers' Compensation Commission has often ordered the insurance company to pay for alternative methods of pain management and outpatient weaning programs to support claimants' efforts in balancing an active lifestyle with lower levels of pain medications. The best thing to do is to talk to your pain management provider. Come up with a plan together to wean slowly down on your opioid use to find a manageable dose. Make sure that your pain management clinic is abiding by CDC guidelines in managing your opioid use and that your provider is communicating with your workers' compensation insurance provider so that you are receiving the authorization and approval for needed treatment. Many times insurance companies will deny benefits simply because the provider is not communicating the treatment plan with them or responding to inquiries.

Can I Choose My Own Pharmacy?

Thursday, February 14, 2019

If I can choose my own doctor can I choose my own pharmacy?

Several times a week we receive calls from clients that they are at their local pharmacy and their prescription was denied. This can often be the pharmacy that will not call the insurance adjuster, the insurance adjuster that does not respond or confusion over the mandatory waiting period to fill narcotic prescriptions. The result is frustration by all parties involved and an onslaught of misinformation ultimately resulting in the delay of much needed prescriptions.

What can I do to avoid this?

To alleviate this stress often clients will choose to use a mail order pharmacy. The mail order pharmacy usually takes the guess work out of why a prescription is denied. The mail order pharmacy is more likely to trouble shoot, call the adjuster directly and even reach out to doctors when a letter of medical necessity is required. Your local pharmacy may be too busy or overwhelmed to make all of these calls on your behalf. The downside is when you are filling opioids or narcotics such as oxycodone or oxycotin there are additional steps that may need to be taken.

With the many restrictions recently put in place to prevent opioid overdoses it may take an extra step or two depending on what medication you are taking. One of these restrictions is the requirement that the physical prescription must be sent to the pharmacy. These restricted medications are not permitted to be e-filed except in limited circumstances or with specific certifications. However, most mail order pharmacies have made it as easy as possible to alleviate the burden on the client. For example, they will provide UPS overnight envelopes to the doctor to overnight the prescription. Also, they recommend you see your doctor a few days before your refill is due and the doctor can post date the prescription, that way by the time the pharmacy receives the prescription it is on the day when the medication can be filled and the pharmacy will overnight the medication with no cost to you.

Can I choose my own pharmacy?

Over the past several years there have been frequent news worthy items regarding pharmaceutical contracts between insurance companies and pharmacies. These contracts allow a specific insurer to provide medications to the insured for less money if the specific pharmacy is used. Often the discount can be as great as 30% less the average wholesale price of the medication. Since the pharmacy is dealing on a very large scale they are able to provide this discount. Depending on the Insurance Company they will allow you to choose your pharmacy, but they will only pay out at the negotiated rate, very similar to doctor's taking the Maryland Workers' Compensation Rate.

While this issue is still being decided in the courts most insurance companies will payout at the charged rate by the pharmacy. It is best to find a mail order pharmacy that serves the Workers' Compensation community exclusively. Often they will forgive the amounts that the insurance company refuses to pay or that the commission will not award and always be aware that the pharmacy is not charging any additional filling fees.

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