State of the States April 21, 2023

lwu 4-21

FDA officials announce potential concerns in relation to immediate-release and extended-release/long-acting opioids.

NationalLate last week, the Federal Drug Administration (FDA) announced updates regarding prescribing information for immediate-release and extended-release/long-acting opioid analgesics. Agency personnel included a new warning concerning opioid-induced hyperalgesia, a condition where opioids cause an increase in pain (hyperalgesia) or an increased sensitivity to pain (allodynia). FDA officials recommend that extended-release/long-acting opioid pain medicines be only for “severe and persistent pain that requires an extended treatment period with a daily opioid medicine and for which alternative treatment options are inadequate.” For patients currently on extended-release/long-acting opioid medication and who experience pain severe enough to need an opioid but are not assessed as having severe or persistent pain, the FDA suggests that a “multimodal approach to pain management is kept available.” 

New figures from the CDC indicate that one out of every five Americans experiences chronic pain symptoms.

NationalThe Center for Disease Control’s latest figures demonstrate that one out of five Americans battles chronic pain. A multi-study review concluded that 20.9 percent of US adults (51.6 million people) experienced chronic pain, with 6.9 percent managing high-impact chronic pain (17.1 million). High-impact chronic pain is defined as “pain that results in substantial restriction to daily activities.” A higher prevalence of chronic pain is observed among non-Hispanic American Indian and Alaska Native adults. Individuals identifying as bisexual or who are divorced/separated also reported significant rates of chronic pain. Geographically, the Midwest records the highest rate of chronic pain, followed by the South, West, and Northeast regions. 

Recent data from WCRI shows that medical payments declined in most states from 2020 through 2021.

NationalRecent Workers’ Compensation Research Institute (WCRI) findings found that workers’ compensation medical payments per claim in several states decreased through 2020 and 2021. Meanwhile, indemnity benefits increased during the same time period. The study looked at 17 state data sets from 2016 through 2021. 

 Legislation intended to improve treatment for chronic pain patients goes to the Governor’s desk for consideration.

injured-workers-pharmacy-blog-coloradoSB23-144 will go to the Governor’s desk after receiving approval from the House and Senate. As written, the legislation aims to improve treatment access for chronic pain patients. Bill language clarifies that a healthcare provider is not subject to disciplinary action for prescribing a dosage that is equal to or more than a morphine milligram equivalent dosage recommendation or threshold specified in state or federal opioid prescribing guidelines. Furthermore, SB23-244 forbids a provider from refusing to accept or to continue to treat a patient solely based on the dosage of a drug a patient requires for the treatment of chronic pain. Pharmacists, health insurance carriers, or PBMs refusing to fill or approve coverage for a drug due to a patient's dosage needs is also prohibited. The bill would become law following the Governor’s signature. 

ODG officials discuss the potential for updated treatment guidelines in the sunshine state.


injured-workers-pharmacy-blog-floridaODG held its webinar on Florida treatment guidelines this week, discussing the potential of updating certain provisions. Personnel from ODG say the discussion is prompted by the state’s three-member panel, which in its formal recommendations, suggested that treatment guidelines be updated under statute 440.13 (14). The webinar focused specifically on the phrase “reasonable and necessary”, emphasizing that while treatment may be reasonable, it may not be necessary. Using Workers’ Compensation Research Institute (WCRI)/ National Council on Compensation Insurance (NCCI) state data, ODG officials cited that costs in Florida were slightly higher than in most states and could be related to physician dispensing practices. The webinar made the case that ODG protocols in Florida could help lower costs as six of the top ten lowest expenditure states for workers’ compensation medical costs were ODG states. Presenters from ODG also claimed that the organization's procedures speed up treatment rather than delay as they ensure that drugs that are reasonable and necessary get to patients quicker. 

A Boston Globe article exposes the deficiencies of the state’s workers’ compensation system.

injured-workers-pharmacy-blog-massachusettsAn article from the Boston Globe highlights shortcomings in the Bay State’s workers’ compensation system. The piece follows the journey of a rehabilitation specialist who suffered a traumatic injury when their workplace’s elevator plunged to the basement from the second floor. Following the workplace incident, the individual said they struggled to receive approval from their employer's workers’ compensation insurer and indicated significant difficulty finding health providers who would accept workers' compensation. Experts familiar with the system believe Massachusetts's low reimbursement rates for workers’ compensation could be the culprit for lagging access. Several health providers say that the current reimbursement rates disincentivize providers from participating and, in turn, potentially delay care for injured workers. As it currently stands, provider reimbursement figures have not been formally updated since 2009 and are the lowest rates nationwide in workers’ compensation. Industry leaders familiar with the state’s system hope that improved rates and encouraging quicker treatment authorization from insurers could help contain costs while simultaneously enhancing accessibility for injured workers.

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