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Opioid use reduction coincides with puzzling cholesterol drug increase

Posted On: Apr. 7, 2016 12:00 AM CST

Workers comp professionals are likely celebrating a reported decrease in opioid utilization while simultaneously scratching their heads over a reported increase in the use of high blood cholesterol drugs.

In its 2015 Workers' Compensation Drug Trend Report, released Tuesday, pharmacy benefit manager Express Scripts Inc. said opioids had a 10.9% decrease in utilization.

Nonsteroidal anti-inflammatory drugs and anticonvulsants, on the other hand, saw 1.4% and 3% increases in utilization last year, respectively, according to Express Scripts' report.

While drug formularies, prescription drug monitoring programs and other efforts are driving the decline in opioid utilization, there is likely some correlation between that decrease and the uptick in NSAIDs like Ibuprofen and anticonvulsants like Lyrica, said Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium.

“The evidence is clear that for anything related to musculoskeletal pain during the acute and subacute phase,” NSAIDs are a more “appropriate treatment than opioids,” Mr. Pew said. But no drug is risk-free, he added, as the long-term use of NSAIDs can cause kidney or liver issues.

The utilization of NSAIDs and anticonvulsants for appropriate patients will likely continue to increase “as there's more scrutiny on opioid prescribing,” said Brigette Nelson, senior vice president of workers compensation clinical management at Express Scripts in Cave Creek, Arizona.

In 2015, two anticonvulsants and three NSAIDs ranked among the 25 most commonly dispensed medications, according to the report. Though, nine of the top 25 drugs were opioids, which continue to be the most expensive and highly utilized therapy class for injured workers, the report states.

The utilization of high blood cholesterol drugs, which aren't usually covered under workers comp, also increased last year, according to the report.

“Typically heart issues are not compensable,” but they are included in some presumptions laws, many of which grant workers comp benefits to firefighters, police officers and other first responders who are presumed to have developed heart disease, for example, on the job, Mr. Pew said.

Ms. Nelson said some of Express Scripts' clients that cover municipalities have “chosen to accept some conditions like treating high cholesterol … which typically wouldn't be considered work related. So that's part of the reason, but most of our formularies don't include those (drugs).”

For the most part, Ms. Nelson said the high blood cholesterol drugs used were traditional statins, but there were a “handful” of pcsk9 inhibitors, which is a new, specialty class of cholesterol-lowering drugs that are “very expensive.”

“We do want to tell our clients to keep an eye on those because they should be reserved for a very small part of the population,” Ms. Neslon said.