However, such treatment doesn't come cheap, as prescriptions account for 19 percent of workers' comp expenses on average, according to a National Council on Compensation Insurance “Winter 2009″ study. Indeed, prescriptions associated with chronic pain may comprise 30-to-40 percent of a comp claim.

Containing these costs is critical for comp insurers, as costs can rise quickly over the lifecycle of a claim.

Many long-term claims involving chronic pain (and their often associated higher utilization of pain medications) lead to increased costs over time.

According to a 2007 NCCI report, prescription drugs typically account for 3 percent of costs on the claim in the first year. But after a seven-year lifespan of the claim, the percentage jumps to 31 percent.

In addition to the challenges of heightened medication costs, overuse of pain medication–specifically opioid use–have shown adverse effects on the overall well-being and treatment of injured parties.

High levels of opioid use have been associated with a high prevalence of adverse outcomes, increased lost time from work and delayed recovery.

Higher utilization levels for opioids can have an adverse impact on both activity levels and on self-sufficiency. Prolonged administration may impede, rather than facilitate, an injured worker's recovery from occupational injuries.

Drug costs associated with chronic pain in workers' comp claims may be decreased using a variety of methods, including substituting generic equivalents for brand-name medications and leveraging pharmacy network discounts. However, savings from these two methods are irrelevant if the medication should not have been dispensed in the first place.

It is important to ensure that all medications dispensed are appropriate for each chronic pain case. This can be accomplished by having medical professionals review the injured worker's therapy.

One solution that payers should take a closer look at is medication therapy management, which enables a pharmacist to optimize an injured party's medications, minimizing complications or interactions.

The purpose of the medication therapy management concept–which was originally established by the Medicare Modernization Act of 2003–is to ensure that medication therapy is individualized to meet the unique needs of the injured party in workers' comp.

To effectively manage medication therapy, insurers and self-insured employers should analyze the injured party's medical history, conduct a comprehensive medication review, look for adverse drug events and carefully monitor drug therapy outcomes.

Based on this initial review, the pharmacist can make recommendations for modifying medication therapy and communicate potential alternative treatment plans to other providers–including insurers, physicians and retail pharmacists–to improve on the injured party's medication outcomes.

Recently, Progressive Medical conducted a study that examined medication therapy management reports completed between July 2007 and July 2008 for a group of workers' comp claims in one jurisdiction.

We found that 90 percent of the reviewed claims had at least one inappropriate medication approved on the claim, while 56 percent had prescription dosages that required modification.

What's more, if every clinical pharmacist's recommendation was followed, as reviewed and approved by the treating physician, the average per-claim savings could amount to more than $6,000 annually.

In chronic pain cases, not only will the recommendations of pharmacists result in reduced costs, they may also improve the therapeutic outcome for injured parties who experience adverse effects from pain medications.

One recent medical study found that a collaborative strategy for chronic pain management–including patient and primary care doctor education as well as frequent reevaluation of the pain plan–provided better relief of pain compared to standard care.

A medication therapy management strategy should effectively meet an insurer's cost-containment objectives. This type of program is generally appropriate for claims that involve chronic pain treatment resulting from injury, have excessive medications, or are more than three years old and show a history of more than one prescribing physician.

In these types of chronic pain cases, it becomes increasingly important for all parties to note changes in behavior to identify red flags. It is also important for claims professionals, pharmacists providing medication therapy management and prescribing physicians to have direct communication regarding recommendations for treatment.

Here's an example of how a chronic pain claim works:

A woman who suffered a right-elbow job-related injury underwent multiple surgeries but still had chronic pain in her elbow and shoulder as well as limited elbow movement. She was prescribed five medications, which caused subsequent conditions of depression and anxiety.

A clinical pharmacist's comprehensive review of the injured woman's medical records and prescription history determined she was being inappropriately treated for insomnia.

The pharmacist and physician recommended elimination of a drug from her regimen, along with treatment for insomnia and depression with a nondrug therapy. As a result, by reducing a medication and incorporating nonpharmacologic therapy, the insurer reduced the annual cost of her claim.

With the U.S. Bureau of Labor Statistics reporting more than four million workers injured on the job each year, payers are looking for ways to reduce costs.

Engaging in a medical therapy management program that includes clinical review by a pharmacist can often result in cost savings of tens of thousands of dollars.

This approach also ensures that injured parties receive appropriate medications to help them get back to work more quickly.

Tron Emptage, RPh, is executive vice president of business development at Progressive Medical Inc. in Westerville, Ohio. He can be reached at [email protected], or 800-777-3574.