Proactive Approach to Manage Narcotics

Oct 29, 2013
Express Scripts Morphine Equivalent Dose (MED) management program helps ensure appropriate utilization to increase patient safety in worker’s compensation
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  • Workers' Compensation Insurance

Ensuring safe and appropriate use of narcotics is a fundamental need for workers’ compensation payers. These drugs have a high potential for abuse and addiction, and overdoses from narcotics cause more deaths each year than cocaine and heroin combined.

As part of an upcoming workers’ compensation offering, the Express Scripts Morphine Equivalent Dose (MED) program is a proactive approach to managing narcotic utilization.

Ensuring Safety of Morphine Equivalent Dose

MED is the calculation used to determine a narcotic medication’s morphine-like potency in conjunction with its dosage. Calculating the MED provides insight into the total dosage of narcotics that an injured worker is being prescribed as part of his treatment regimen.

According to the Washington State Agency Medical Director’s Group (AMDG), patients receiving 100mg or more per day of MED had a ninefold increase in overdose risk.

How Does It Work?

Express Scripts’ MED program is a real-time, proactive approach to managing narcotic utilization in workers’ compensation. When a prescription is presented at the pharmacy, Express Scripts’ proprietary claims processing system calculates the MED value for the individual prescription and the cumulative level for all the medications the injured worker has been prescribed. If the prescription does not exceed the client-specified MED threshold, the prescription is filled. If either the individual or cumulative MED values are too high, the prescription is submitted to the payer to review for appropriateness.

New Solution for Narcotic Management

By accounting for individual prescriptions as well as cumulative levels, the MED program enables payers to have a broader management of narcotic utilization, while ensuring injured workers maintain access to needed medications.

Most importantly, this keeps injured workers safe. As stated in the AMDG guidelines, “Effective use of opioids must result in clinically meaningful improvement in function, and a decrease in pain intensity in the absence of improved function is not considered clinically meaningful.” The AMDG guidelines also recommend that injured workers seek pain management consultation when MED is more than 120mg a day.

When payers can aggressively and proactively manage narcotic utilization, they minimize risks for misuse and improve health outcomes for injured workers.

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