In August, the U. S. Drug Enforcement Administration (DEA) published the Final Rule moving hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II status. How will the healthcare and insurance communities respond to this ruling?
For many years, the healthcare and insurance communities have debated the most cost effective ways for treating patient pain from chronic medical conditions. The more restrictive ruling by the DEA will bring a greater focus by physicians and insurers to find alternatives to HCP prescriptions.
Historically, HCPs are the most prescribed medications in America. With 135 million prescriptions filled in 2012, they are prescribed 25 percent more often than the next prescribed medication. For several years, a physician prescription for an HCP medication has resulted in a predictive “flag” for self-insurers and insurers to monitor potential longer term “legacy” or “chronic” claims. For payers, the view is that an HCP prescription has been an easy way for the physician or healthcare provider to satisfy the complaint of a patient’s pain without finding alternative therapies or medications. Healthcare providers will now be forced to consider alternatives with the more restrictive ruling. What options will they be considering?
Some of the best healthcare teams in the country have recognized and utilize a holistic approach to long term case management. For patients and their families, WebMD offers a Pain Management Health Center to become initiated with the symptoms, therapies and medications. Their 11 Tips for Living With Chronic Pain is a helpful guide for patients and their families to learn more about alternatives, with their physician and medical team’s guidance. Other sections in the Pain Management Health Center will provide additional guidance about specific root causes of pain.
Additionally, there are several well-known pain management clinics around the country for consultation with specific needs. Those clinics include The Mayo Clinic’s Pain Rehabilitation Center in Minnesota, The Cleveland Clinic’s Chronic Pain Rehabilitation Program, The Stanford University Pain Management Center, and The Johns Hopkins Blaustein Pain Treatment Center, among others near the patient and their family. Rather than taking medications alone, these and other treatment centers will offer specific tailored pain management approaches to individual needs.
While the consultations are modestly more expensive at the beginning of a treatment plan, over the long term the patients and families are better served with better pain management results. For payers, it may be very cost effective to consider a pain management consultation as soon as a claim “flag” is encountered. Solutions that provide a holistic approach will ultimately lead to better, and fairer, outcomes for the patient and payers.