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Pharmacy Resource GuideSeptember 2017 | Workers’ Compensation

3

Information contained in this Pharmacy Resource Guide is provided “as is” for informational purposes only and is not intended to constitute legal advice. Due to the rapidly changing nature of regulatory information, Optum does not warrant or guarantee the accuracy of content of this Guide. Before taking any action on the reimbursement or delivery of care based upon our Guide, the reader should consult their legal representatives.

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Table of Contents

4 2017 pharmacy state fee schedule detail

6 Maps of jurisdictional laws and regulations

12 2017 continuing education program, September to December 2017

13 Our perspective on opioid analgesics

14 Timeline of activity addressing opioid use in workers' comp and auto no-fault

16 Opioid analgesic laws

20 Brand-generic Index

25 Generic-brand Index

30 Opioid analgesic stats

31 Sources

We are pleased to share this Pharmacy Resource Guide offering insight on workers’ compensation jurisdictional laws and regulations, including a state-by-state guide to the pharmacy fee schedule along with updated statistics on opioid analgesics. We have also included a timeline of opioid analgesic legislative activity and medication releases spanning forty years, including our role in shaping the pharmacy benefit manager.

Additionally, we have included the remaining 2017 Continuing Education schedule and a helpful Brand-Generic Index of commonly used workers’ compensation medications.

Questions about our program may be shared with your account manager or clinical services.

Pharmacy Resource GuideSeptember 2017 | Workers' Compensation

4

2017 Pharmacy state fee schedule detailLegendBR = Brand Rate (% of AWP) + Dispense FeeGR = Generic Rate (% of AWP) + Dispense Fee

Reimbursement DescriptionPhysician Dispensed/RepackagedCompounded Medications

AK BR AWP + $5.00GR AWP + $10.00

Lesser of FS, fee to general public, or negotiated fee.

Reimbursement shall use the original manufacturer's AWP.

Reimbursement shall be limited to “medical necessity” and for each ingredient listed separately by NDC plus a $10 DF.

BR AWP + $5.13GR AWP + $5.13AR

Lesser of FS, provider’s U&C, or MCO/PPO contract price.

No DF to physicians. OTCs billed by physicians reimbursed at provider’s charge or up to 20% above cost of item. Dispensing practitioners must obtain permit (from state) and demonstrate need prior to dispensing approval.

BR AWP + 5% + $9.02GR AWP + 5% + $11.71AL

Lesser of FS or provider’s U&C.

Bills shall include original underlying NDC and NDC of repackaged/relabeled product. Reimbursement is lesser of original AWP and repackaged/relabeled AWP. DF payable only to pharmacies.

BR AWP - 5% + $7.00GR AWP - 15% + $7.00AZ

Reimbursement is based on actual medication dispensed. Medicines dispensed by either pharmacy or physician subject to FS.

Bills for physician dispensed/repackaged medications shall include NDC of medication dispensed and original manufacturer NDC. Reimbursement based on NDC of underlying medication product.

Reimbursement based on AWP of underlying medicine product and bills shall include NDC for each ingredient used.

BR AWP - 17% + $7.25GR AWP - 17% + $7.25CA

FS set at 100% of current Medi-Cal fee schedule. Lesser of AWP - 17% / MAC or FUL or U&C plus a DF.

If NDC of dispensed medication not in Medi-Cal but NDC of underlying medication is, use NDC of underlying medication. If NDC from original labeler not in Medi-Cal, max fee is 83% of AWP of lowest priced therapeutically equivalent medication plus relevant DF.

Billed using NDC of each ingredient. If no NDC, ingredient not reimbursable. Reimbursement for physician dispensed compounds not to exceed 300% of documented paid costs, or $20 above.

COIf AWP ceases, substitute with WAC + 20%.

For repackaged medications use AWP and NDC of underlying medication.

Rates for prescription strength topical compounds categorized according to four state-specific Z codes. Fees represent maximum reimbursable amount. All compound ingredients must be listed by quantity used. Certain topicals without a prescription are $30 for 30-day supply. Certain pain patches are $70 for a 30-day supply.

BR AWP + $4.00GR AWP + $4.00

CTReimbursement lesser of NDC for underlying medication from manufacturer or therapeutic equivalent medication product from manufacturer NDC. If information pertaining to original manufacturer is not provided or is unknown, payer may select NDC and associated AWP for reimbursement.

BR AWP + $5.00GR AWP + $8.00

DELesser of provider’s U&C, negotiated contract amount, or FS.

Reimbursement based on AWP for underlying medication product, as identified by its NDC, from original labeler. Physicians dispensing from office do not receive DF. No practitioner, unless properly licensed, shall dispense a controlled substance beyond a medically necessary 72-hour supply.

Billed listing each ingredient and separately calculating charge using NDC; single compounding fee of $10 per prescription.

BR AWP - 31.3% + $3.22 DFGR AWP - 37.5% + $4.02 DF

NMLesser of FS, U&C, or contracted rate.

Reimbursement at AWP - 10% with no DF. Initial physician dispense not greater than 10 days for new prescriptions. Provider dispensed medications shall not exceed cost of generic equivalent.

Reimbursed at ingredient level, plus single DF. Bills must include original NDC. Ingredients with no NDC not reimbursable.

BR AWP - 10% + $5.00GR AWP - 10% + $5.00

NDBased on a markup above WAC, except compounds.

Reimburses compounds at AWP - 72%, plus a single item compounding fee based on level of effort (LOE).

BR WAC + 8% + $4.00GR Lesser of: MAC + 5% or WAC + 8% + $5.00

MTLesser of FS or provider’s U&C.

Practice limited to certain exceptions.

BR AWP - 10% + $3.00GR AWP - 25% + $3.00

MSUnless contract, reimbursement is lesser of provider’s total billed charge or FS.

Reimbursed using NDC from underlying medication product from original labeler. DF not payable to doctors.

Bills shall include listing of each individual ingredient NDC. Reimbursement sum of AWPs of each underlying NDC medication product + $5 DF, and limited to a max of $300 per 120 grams per month quantity (without prior authorization).

BR AWP + $5.00GR AWP + $5.00

MNFS is bifurcated depending on paper billing and electronic or “real-time” billing and payment (as required) and includes MAC for GR.

Permitted if not for profit, or if for profit, physician must file with the appropriate licensing board and receive approval.

*Electronic. Paper for both BR and GR is AWP + $5.14

BR AWP - 12% + $3.65*GR AWP - 12% + $3.65*

MILesser of MAR in FS or provider’s U&C charge.

Billed and reimbursed based on original manufacturer’s NDC.

Reimbursement for “custom” compounds limited to max of $600 (charges exceeding subject to review). Topical compounds billed using specific amount of each ingredient and original manufacturer’s NDC. Reimbursed at max of AWP -10% of original manufacturer’s NDC, pro-rated for each ingredient, plus a specific DF. Ingredients without NDCs not reimbursed. Additional “medical necessity” requirements on custom and topical compounds. Non-compound OTC topicals addressed separately.

BR AWP - 10% + $3.50GR AWP - 10% + $5.50

MAFS tied to Medicaid rate.

Permitted only when necessary for immediate and proper treatment until possible for patient to have prescription filled by a pharmacy.

Additional DF amounts depending on type of ingredients.

BR Lowest of: MMAC, AAC or U&C + 10.02GR Lowest of: FUL, MMAC, AAC or U&C + 10.02

BR AWP + 10% + $10.51GR AWP + 40% + $10.51LA

DF is based on current state Medicaid DF.

Physicians may only dispense controlled substances or medications of concern if registered as a dispensing physician and only up to a single 48-hour supply.

Paid at FS formula for generics and bill must indicate “COMPOUND Rx” on form.

KYReimbursement at lower amount permitted if agreed.

Reimbursement based on AWP of original NDC. DF only payable to licensed pharmacist. Doctors are restricted to dispensing only a 48-hour supply of any CII or CIII medication containing hydrocodone from their office.

AWP of the compound medication is to be determined using the NDC of the original product from the manufacturer.

BR AWP + $5.00GR AWP*+ $5.00

*Of lowest priced therapeutically equivalent in stock

IDReimbursement is lesser of FS, billed charge, or charge agreed to pursuant to contract.

Reimbursement based on AWP of original manufacturer. Physicians not reimbursed a DF or compounding fee.

Reimbursed at sum of AWP of each individual medication, plus a $5 DF and $2 compounding fee. Ingredients of compounds require NDC of original manufacturer.

BR AWP + $5.00GR AWP + $8.00

HIRepackaged medications reimbursed at fee schedule based on original manufacturer NDC.

Reimbursed at fee schedule based upon gram weight of each underlying ingredient. AWP shall be set by the original manufacturer.

BR AWP + 40%GR AWP + 40%

GAReimbursement based on current published manufacturer’s AWP of product on date of dispensing.

Bills must include NDC of original manufacturer/distributor’s stock package.

Must be billed by the compounding pharmacy. Reimbursement shall be the sum of AWP for each ingredient -50% plus a single compound fee of $20. Reimbursement limited to compounds containing three or fewer active ingredients.

BR AWP + $4.31GR AWP + $6.45

FLReimbursement at FS except where employer/carrier or entity “acting on behalf of” employer/carrier directly contracts with provider seeking lower reimbursement.

AWP for repackaged/relabeled medications dispensed by “dispensing practitioner” shall be AWP of original manufacturer/underlying medication +12.5% + $8 DF. Must include original NDC.

Permitted when prescribed formulation not commercially available and reimbursement shall be AWP of each ingredient + $4.18 DF.

BR AWP + $4.18GR AWP + $4.18

NVLesser of FS, U&C, or contracted rate.

May dispense initial supply (15 days) of CII or CIII. Include original NDC on bills. May not charge or seek reimbursement for OTC.

Reimbursement based upon agreement and includes quantity prior to dispense. All compound bills shall list individual ingredients and NDC. Ingredients lacking an NDC shall not be reimbursed.

BR AWP + $10.94GR AWP + $10.94

KSLesser of FS or provider’s U&C.

Reimbursed at fee schedule based on original manufacturer’s NDC and require prior approval of carrier.

Same as physician dispensing.

BR AWP - 10% + $3.00GR AWP - 15% + $5.00

NCLesser of FS or an agreement between the provider/payer.

Original manufacturer's NDC required on bills for repackaged and doctor dispensed medications. Reimbursement for doctor dispensed medications shall not exceed 95% of AWP and based on AWP of the original NDC. No outpatient provider (other than pharmacies) may receive reimbursement for any CII through CV medications over an initial 5-day supply commencing on the employee's initial treatment.

BR AWP - 5%GR AWP - 5%

5

DC Paid at U&C.

IA Paid at U&C.

IL Insurer pays all necessary and reasonable costs.

Medications dispensed outside of licensed pharmacy are AWP + $4.18 and repackaged medications use AWP of underlying medication as identified by NDC from original labeler.

IN Reimbursement for repackaged medications dispensed (other than retail/mail pharmacy) use AWP of original manufacturer. If NDC not determined, max reimbursement is lowest cost generic for prescribed/dispensed medication.

Doctors dispensing medications from their office(s) are only entitled to receive reimbursement for medications dispensed during the first 7 days from DOI.

MD For medications or products lacking FS, carriers can assign a relative value to product/service. May be based on nationally recognized/published relative values or values assigned for similar products/services.

ME Paid at U&C.

MO Paid at U&C.

NE Paid actual charge billed unless payor has evidence exceeds regular charge for service by NE providers.

NH Pay reasonable value.

NJ Paid at U&C.

Physician dispensing limited to only 7-day supply unless more than 10 miles from nearest pharmacy. Additional limit on charges.

SD Not to exceed U&C.

UT Paid at U&C.

Physician dispensing permitted only in very limited situations.

VA Disputes use prevailing community rate.

Physician dispensing only permitted with certain specified limits (i.e., samples, emergency, not available) unless properly licensed by the Board of Pharmacy.

WV No Controlling Rx FS – Providers bill their U&C.

Legend medications dispensed by a physician will not be reimbursed except in emergency.

NO FEE SCHEDULE

Abbreviations: AAC = Actual Acquisition Cost AWP = Average Wholesale Price DAW = Dispense as Written DF = Dispensing Fee DFEC = Division of Federal Employees’ Compensation DNS = Do Not Substitute DOI = Date of Injury FS = Fee Schedule

FUL = Federal Upper Limit IW = Injured Worker MAC = Maximum Allowable Cost NDC = National Drug Code OTC = Over the Counter POS = Point of Sale SMN = Statement of Medical Necessity U&C = Usual and Customary WAC = Wholesale Acquisition Cost

ORLesser of FS, provider’s U&C, or contracted rate.

Compensability of physician dispensing limited to initial 10-day supply except in emergency.

Must be billed by ingredient, listing each ingredient's NDC (ingredients w/o NDC not reimbursable). Max fee = AWP-16.5% for each ingredient + a single $10 compounding fee.

BR AWP - 16.5% + $2.00GR AWP - 16.5% + $2.00

OKLesser of FS or provider’s U&C for same or similar service.

Physician dispensed (non–repackaged) lesser of AWP - 10% or payer’s contracted rate. Repackaged medications reimbursed at lesser of AWP for original NDC - 10% or AWP of lowest cost therapeutic equivalent medication - 10%.

Shall be billed by compounding pharmacy at the individual NDC ingredient level. Reimbursement shall be sum of allowable fee for each ingredient, plus a single $5 DF. Ingredients without NDC not reimbursed.

BR AWP - 10% + $5.00GR AWP - 10% + $5.00

OHLesser of U&C or FS.

Medications supplied to IW in physician’s office not considered outpatient medication and not reimbursed by BWC or MCO. Repackaged brand medications product cost component shall be calculated using AWP of original labeler (repackaged generics not addressed). Only pharmacy providers eligible for DF.

Billed and reimbursed based on ingredient NDCs (no reimbursement for ingredients without NDC). Max product cost component reimbursement for any one compounded Rx is $400. Dispensing fee(s) for non-sterile compounds shall be $18.75 and $37.50 for sterile compounds.

BR AWP - 15% + $3.50GR AWP - 15% + $3.50

NYFS or lower contracted rate.

Physician dispensing limited to 72 hours with exceptions. Repackaged medications reimbursed based on AWP for underlying medication.

Reimbursed at ingredient level. Payment based on sum of allowable fee for each ingredient, plus a single DF per compound. Ingredients with no NDC not reimbursable.

BR AWP - 12% + $4.00GR AWP - 20% + $5.00

PAIf provider’s actual charge less than FS, pay actual charge.

Reimbursement shall be at FS based on original manufacturer’s NDC, which must be submitted on bill. If original NDC is not submitted, reimbursement shall be FS of the least expensive clinically-equivalent medication. Outpatient providers (other than licensed pharmacies) may not seek reimbursement for Schedule II medication in excess of an initial 7-day supply commencing on “initial treatment” for specific WC claim. Should an IW require a “medical procedure,” one additional 15-day supply permitted, commencing on date of procedure. Providers may not seek reimbursement for any other prescription medications in excess of an initial 30-day supply, commencing on “initial treatment” by a provider for specific WC claim and may not seek reimbursement for an OTC medication.

BR AWP + 10%GR AWP + 10% WI

DF only payable to pharmacist. Reimbursed at existing pharmacy FS.

BR AWP + $3.00GR AWP + $3.00

WAL&I (state fund) does not pay for medication dispensed in physician’s office and policy is to not pay for repackaged medications.

Reimbursement allows cost of ingredients, plus a $4.50 professional fee and a $4 compounding time fee. Must be billed with NDC for each ingredient. Compounds require pre-authorization.

BR AWP - 10% + $4.50GR AWP - 50% + $4.50

VTLesser of FS or actual charge.

BR AWP + $3.15GR AWP + $3.15

TXReimbursement at compliant contracted rate (a direct contract with provider or through a registered pharmacy network) or lesser of FS or billed amount.

Physician dispensing only permitted to meet immediate needs or in rural area.

Calculate each ingredient separately (AWP in FS) plus a $15 compounding fee per prescription. Bills shall include each medication included in the compound.

BR AWP + 9% + $4.00GR AWP + 25% + $4.00

TNLesser of FS, provider’s U&C, or contracted rate.

Reimbursement based on published manufacturer’s AWP of product/ingredient, calculated on a per unit basis, on date of dispense. If original manufacturer’s NDC not provided on bill, reimbursement based on AWP of lowest priced therapeutically equivalent medication. Physician should not receive a DF.

Compounding fee not to exceed $25 per compound and may be charged by any entity other than physician. All compound bills shall include NDC of original manufacturer.

BR AWP + $5.10 GR AWP + $5.10

WYLesser of FS or provider’s U&C.

Physicians billing for compounds must provide pharmacy invoice and pay at 130% of supplier’s/manufacturer’s invoice price.

Compounding pharmacies that bill are compensated per FS, per line item if ingredient determined coverable. Pharmacists/third-party billers must submit itemization for all ingredients and quantities used in compounding process.

BR AWP - 10% + $5.00GR AWP - 10% + $5.00

RIPhysicians cannot bill for dispense, only for administered medications (injectable medications) in office.

Compounds containing repackaged medications shall be reimbursed using NDC of the underlying medication. Compounds shall be billed by separating the ingredients by NDC and corresponding quantity. Reimbursement for topical compounds shall not exceed $500 for a 30-day supply.

BR AWP - 10% GR AWP - 10%

SCLesser of FS or provider’s U&C.

Billed with original NDC and reimbursed accordingly. If original NDC not provided or unknown, payer shall select most closely associated AWP.

Billed by listing each ingredient NDC and reimbursed at sum of each NDC’s amount, plus a single $5 DF (payment not required for ingredients lacking an NDC).

BR AWP + $5.00GR AWP + $5.00 FEDERAL SERVICES

BR AWP - 15% + $4.00 DFEC AWP - 10% + $4.00 Non-DFEC

GR AWP - 40% + $4.00 DFEC AWP - 25% + $4.00 Non-DFEC

Lesser of FS or U&C charge amount.

For OWCP programs, all medications dispensed from physician’s office and submitted with codes J3490, J8499, J8999, and J9999 require accompanying original NDC. For FECA/Black Lung any doctor dispensed Rx submitted using CPT code 99070 require accompanying original NDC.

DFEC has specific prior-authorization processes for compounds. Compounds shall be billed at ingredient level, including NDCs. Reimbursement for compounds with three or less ingredients shall be AWP - 50% of each NDC. Reimbursement for compounds with four or more ingredients shall be AWP - 70% of each NDC.

Jurisdictional Generic Medication Mandates Substitution mandated

Substitution mandated except where prescriber notate DAW, DNS or similar

Substitution mandated except where written statement of medical necessity, prior authorization or other requirement provided/met

Substitution not specifically mandated for workers’ comp

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© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502

WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

HI

FIGURE 1

MEDICATION FORMULARIES AND GUIDELINES

None

WC Treatment Guidelines

WC Treatment Guidelines, as well as State WC Specific Formulary or Preferred Drug List (PDL)


WA

OR*

CA

NV

ID

MT*

WY*

COUT

NMAZ

TX*

OK

KS

NE

SD

ND* MN

WI*

IL

IA

MO

AR

LA

AL

TN*

MIPA

NY

VT*

GA

FL*

MS

KY*

SC

NC

MDOH* DEIN WV*

NJCT

MA

ME*

RI

VA

NH

AK*

DC

HI

FIGURE 2

JURISDICTIONAL GENERIC MEDICATION MANDATES

Substitution mandated except where prescriber notate DAW, DNS or similar

Substitution not specifically mandated for WC

Substitution mandated except where written statement of medical necessity, prior authorization or other requirement provided/met

Substitution mandated

FIGURE 1: Reflects most current published jurisdictional workers’ compensation treatment guidelines or formularies (prescription medication utilization specific). Current as of August 2017.

FIGURE 2: DAW = Dispense as Written DNS = Do Not Substitute Data – Reflects published state statutes/regulations on generic dispensing. *Indicates injured worker can pay difference between brand and generic when brand dispensed without proper authorization. Current as of August 2017.

Maps of workers' comp (WC) jurisdictional laws and regulations

7


WA*

OR

CA

NV

ID

MT

WY

CO*UT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL*

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI*

VA

NH

AK

DC

HI

FIGURE 3

USE OF ORIGINAL NDC FOR REPACKAGED MEDICATIONS

No mandate for use of original NDC for billing/reimbursement

Mandates use of original NDC for billing and/or reimbursement

FIGURE 3: *Additional regulatory/statutory factors and qualifications may apply. Data – Reflects published statutes/regulations/case law on usage of underlying NDC for repackaged medications. Current as of August 2017.

FIGURE 4: FS = Fee Schedule MAR = Maximum Allowable Reimbursement U&C = Usual & Customary Charge | Note – Categories represent interpretation of state requirements. Some states use tiered/multiple levels of reimbursement. Data – Reflects published State Fee Schedules. Current as of August 2017.

Maps of WC jurisdictional laws and regulations


WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

HI

FIGURE 4

DURABLE MEDICAL EQUIPMENT AND SUPPLIES STATE FEE SCHEDULE

Medicare allowable (may be +/– percentage markup)

State-established MAR

Not regulated or addressed/no specific FS established

Provider cost and/or invoice amount plus markup

Provider billed charge (may be +/– percentage markup)

U&C or reasonable amount

State Medicaid allowable

8

FIGURE 5: Note – States such as AR, DE, FL, KY, NY, and TN have overlapping workers’ compensation and state Practice Act controls. Data – Reflects published state statutes/regulations/case law on Physician Dispensing/Repackaging. Current as of August 2017.

FIGURE 6: Note – Categories set according to statute/regulation/case law relating to direction of care for pharmacy benefit/medical provider networks. Does not reflect dispensing physicians. Current as of August 2017.


WA

OR

CA

NV

ID

MT

WY

HI

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

FIGURE 6

PHARMACY DIRECTION OF CARE

Statute/regulation silent or unclear

Potentially permitted with restrictions/qualifications

Prohibited by statute/ regulation/case law

Permitted under regulatory conditions


WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

HI

FIGURE 5

PHYSICIAN DISPENSING/ REPACKAGING RESTRICTIONS

WC statutes/regulations limit physician dispensing and/or repackaging (restrictions on dispensing, billing, and/ or reimbursement).

No clear legal or WC limits on physician dispensing and/or repackaging

Legal restrictions on physician dispensing (Practice Act)

Legal restrictions (Practice Act) in addition to WC controls


9

© 2016 Optum All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. -

WA*

OR

CA*

NV*

ID

MT

WY*

COUT

NMAZ

TX

OK*

KS*

NE

SD

ND* MN

WI

IL

IA

MO

AR

LA

AL

TN

MI* PA

NY*

VT

GA*

FL*

MS*

KY*

SC

NC

MDOH* DEIN WV

NJCT

MA

ME

RI*

VA

NH

AK*

DC

HI

FIGURE 7

COMPOUNDED MEDICATIONS

Not addressed by specific WC regulations/fee schedules

Individual ingredient(s) NDC required on compounded medications bills

Language explicitly permits denial of reimbursement for individual ingredients lacking an NDC

Unique state compounded medications reimbursement/ billing qualifiers and/or provisions

FIGURE 7: *Additional state regulatory/statutory language regarding billing and reimbursement for compounded medications (including physician dispensed compounded medications). Data – Reflects published statutes/regulations/fee schedules related to workers’ compensation compounded medication billing/ reimbursement. Current as of August 2017.

FIGURE 8: Note - Map reflects eBilling mandates inclusive of all workers’ compensation medical and pharmacy services. Data – Reflects published statutes regulations requiring eBilling or published implementation guides with an eBilling effective date. Current as of August 2017.


WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

HI

FIGURE 8

eBILLING REGULATIONS

eBilling not mandated

Mandated on providers/payers

Regulations adopted but not mandated on providers

eBilling regulations under development or legislatively required to be developed


10

FIGURE 9: Source: ProCon.org. Current as of August 2017. FIGURE 10: Data – Reflects current Naloxone policies. Source: pdaps.org. Current as of August 2017.


WA

OR

CA

NV

ID

MT

WY

COUT

NMAZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN

WV

NJCT

MA

ME

RI

VA

NH

AK

DC

HI

FIGURE 10

NALOXONE

Naloxone access and medication overdose Good Samaritan laws

Naloxone access and Good Samaritan laws are limited and only applied to people under 21 who offer medical assistance to another experiencing an overdose from prescription medications

Naloxone access laws only



WA

OR

CA

NV

ID

MT

WY

COUT

AZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

NM*

HI

FIGURE 9

MEDICAL MARIJUANA

Legalized medical marijuana

Medical use of marijuana currently prohibited

Medical use of marijuana currently prohibited with legalized usage of cannabidiol (CBD) for limited purposes

Legalized recreational and medical marijuana

11

FIGURE 11

INITIAL OPIOID PRESCRIBING LIMITS

No recent policies enacted

Seven-Day Supply

Five-Day Supply

Three-Day Supply

Other – AR (schedule II and rule-making), MD (lowest effec-tive dose), NH (30-day acute; seven day in ER), NV (14-day), PA (hospitals and urgent care only), RI (MME Level), VT (MME Level), WA (rule-making)

FIGURE 11: Data – Reflects adoption of policies enacting initial opioid prescribing limits. Note – Initial days supply limitations can vary across jurisdictions. Additionally, these policies are not unique to workers’ compensation or auto no-fault. *Indicates requires rule-making/development to support full implementation. Current as of August 2017.



WA

OR

CA

NV

ID

MT

WY

COUT

AZ

TX

OK

KS

NE

SD

ND MN

WI

IL

IA

MO

AR

LA

AL

TN

MIPA

NY

VT

GA

FL

MS

KY

SC

NC

MDOH DEIN WV

NJCT

MA

ME

RI

VA

NH

AK

DC

NM*

HI

12

2017 Continuing Education program

AccreditationAll courses will be submitted for 1.0 hour of pre-approved Adjuster (AK, AL, CA, DE, FL, GA, IN, KY, LA, MS, NC, NH, OK, TX, UT, WY); Certified Case Manager (CCM); National Nurse; Certification of Disability Management Specialists (CDMS); Commission on Rehabilitation Counselor (CRC); and Certified Medicare Secondary Payer (CMSP) CE accreditation. For states that do not require prior approval, the adjuster will need to submit their attendance certificate to the appropriate state agency to determine if CE credits can be applied. The Settlement Solutions courses will also be submitted for 1.0 hour of Continuing Legal Education (IL, CA, FL, TX).

Approval information varies by course and will be updated on HeliosComp.com.

Continuing education credits for our courses are administered by the CEU Institute. If you have any issues or questions regarding your credits, please contact [email protected].

Register at HeliosComp.com/Resources/Education

Continuing Education courses and dates (September through December) All webinars will be held from 2:00-3:00 p.m. (EST)

October 26 . . . . . . . . Path to success when coordinating home health services

November 16 . . . . . . Major multiple trauma in workers' comp and auto no-fault

December 14 . . . . . . Using data to look beyond what you see

http://www.HeliosComp.com/Resources/Education

13

Our perspective on opioid analgesics

Opioid analgesics have a place in therapy; knowing when and how to use is key

The recent agreement between the U.S. Food and Drug Administration (FDA) and Endo Pharmaceuticals to have Opana® ER removed from the U.S. market highlights the ongoing need for awareness on the safety of opioid analgesics and a better understanding of how the medication can affect the major body systems. While this decision resulted from research determining the benefits of using reformulated Opana ER no longer outweigh its risks, the question of whether or not opioid analgesics should continue to have a place in medication therapy remains.

In our experience, a time and place for opioid analgesics exist in the treatment of injury-related pain. For post-surgical pain and acute injuries, such as fractures and crush injuries, the initial pain may not be controllable with non-opioid analgesics. It is during this early phase of the injury that short-acting opioid analgesics, such as hydrocodone and oxycodone, may be medically necessary and should be an available treatment option, if appropriate for the claimant and in accordance with prescribing and/or treatment guidelines. However, it is also during this timeframe, after the acute pain intensity decreases, that the plan for ongoing pain management should be developed and discussed with the claimant. When doing so, a straightforward approach is often the most effective. For instance, the prescriber may state the following… “this (opioid) medication will help control your pain over the next several days but it is not intended to be used on a long-term basis for this type of injury. Over the next couple of days, the amount of this medication being taken should be decreased and I am going to provide you with instructions on how to do this. At the same time, it is important to bring your pain under sufficient control while keeping you moving and active as your body starts to heal.”

Based on the individual claimant’s injury and specific circumstances, an expected date for discontinuing opioid analgesics should also be established before the first opioid prescription is filled. Furthermore, as with all medical treatments (pharmacologic and nonpharmacologic), the benefits of treatment need to outweigh the risks and the claimant should demonstrate understanding of those benefits and risks. While situations and complications may arise requiring a longer duration of pain management, additional non-opioid analgesic treatment measures should be incorporated, such as adjuvant pain medications, psychological evaluation and physical medicine treatments.

Opioid analgesics are not generally recommended for the ongoing (chronic) treatment of injury-related pain as they are often associated with increasing side effects, tolerance, drug-drug interactions, as well as the potential for abuse, misuse and addiction. However, for those claimants with chronic pain who are demonstrating a safe and compliant use of their opioid analgesic medications, along with well-documented and objective improvements in their level of function, the ongoing use of opioid analgesics at the minimally required dosage may not be, by itself, inappropriate. In fact, the early discontinuation of opioid analgesics in claimants with genuine pain symptoms can place some claimants at increased risks from the excessive use of other non-opioid analgesics, such acetaminophen and nonsteroidal anti-inflammatories. Therefore, a holistic view of the claimant’s current condition and risks to help make better decisions for their continued pain control and quality of life is essential.

14

Nearly 40 years ago, claimants faced difficulty having their claim-related, workers’ comp and auto no-fault prescriptions filled. Pharmacies often didn’t know how or where to invoice those prescriptions and thus were faced with potentially not being reimbursed for dispensing the medication. The introduction of the pharmacy benefit manager (PBM) resolved the access issue by introducing the use of a pharmacy network geared towards the processing of prescription transactions for particular payers, including workers’ comp and auto no-fault. PBM involvement also lowered pharmacy costs for payers as network discounts were applied to in-network transactions, reduced bill processing fees and other administrative inefficiencies and increased access to pharmacy data. In the years that follow, emphasis on driving transactions in-network remains paramount, particularly as pharmacy costs grow to approach nearly 20% of overall medical spend.

As network penetration increases, payers experience even lower pharmacy costs, become better equipped to holistically manage the claim, and the safety and efficacy of the claimant’s medication therapy improve. Programmatic business rules, drug utilization review criteria and injury-based formularies can be more refined and widespread. Advanced network enforcement capabilities along with improvements in electronic adjudication, including connectivity from pharmacy to payer, facilitate better monitoring and measurement of data. Increased knowledge about the dispensing process and pharmacy utilization yields better clinical management throughout the care continuum. As a result, payers start to see how better pharmacy management can influence overall medical spend, a claimant’s functional restoration and/or return to work and their overall health status.

As a pioneer in opioid management, Optum continues to collaborate with stakeholders throughout the system, leading the way towards healthier outcomes.

*BEFORE 1995: Early 1800’s: Morphine 1926: Dilaudid® 1942: Demerol® 1947: Dolophine® 1950: codeine 1950: Percodan®

1971: Percocet® 1983: Vicodin® 1986: Buprenex® 1987: MS Contin® 1990: Fiorinal® with codeine 1990: Duragesic® 1992: Fioricet® with codeine

*Reformulated to include abuse-deterrent properties. No medication is 100% abuse-deterrent. Medications in bold: Top 25 medications by spend

*Removed from market at FDA request

ONCE A PRESCRIPTION IS IN-NETWORK, YOU CAN ADDRESS UTILIZATION

MANAGING PHARMACY BENEFITS STARTS WITH THE NETWORK

AL CONV

NO REMARKABLE REGULATORY OR LEGISLATIVE ACTIVITY

Oxycontin®

Ultram®

Norco®

Vicoprofen® Roxicodone®

Kadian®

Ultracet®Actiq®

Avinza®

Subutex® Ultram® ERFentora®

Opana®*

1995* 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

A timeline of activity addressing opioid use in workers’ comp and auto no-faultMedication releases and regulatory and legislative activity

15

MANAGING PHARMACY UTILIZATION OFTEN REQUIRES CHANGE

THE MORE YOU KNOW, THE GREATER YOUR INFLUENCE

The ability to measure pharmacy activity allows PBMs and payers to act when the medication therapy regimen presents a concern. Identifying the need for change however, doesn’t automatically mean the change will occur. Often times a lack of expertise or resources along with competing priorities result in failure to take action. Similarly, incomplete health-related information or misinformation about a claimant’s entire treatment plan can cause prescribers to manage a claimant differently than they might otherwise, were more complete pharmacy information available.

To address these challenges, PBMs add a variety of outreach tools to facilitate multi-disciplined care coordination and information sharing. Pharmacist reviews, specialty-matched peer-to-peer evaluations, and the use of drug testing and monitoring (to name a few) are now deployed with greater frequency, much earlier in the claim lifecycle. When done correctly, this collaborative effort can have a dramatic effect: claimants receive the right medication at the right time, in the right dose and for the right duration. Meanwhile, payers avoid paying for the most expensive prescription; the one that should not have been paid in the first place.

With cost and utilization management tools in place, the PBM metamorphosis continues. There is an even greater focus on efforts to increase understanding within the payer community. Emphasis on enabling claims management professionals to take more proactive action also take center stage. Continuing education programs, interactive resource guides, white papers and other educational tools help payers dissect and better understand pharmacy and its influence on claim outcomes. The use of statistical analysis unleashes the predictive power of pharmacy data. As data and analytics pair with clinical expertise, payers intervene earlier in the lifecycle of those claims where their professional influence is needed most. These actions further drive down costs. Importantly, because the PBM has transformed into a provider of pharmacy care services, payers experience even greater value from their program starting with the first fill and enduring all the way through claim resolution and/or settlement due to increased administrative efficiency, shorter pharmacy claim duration, fewer instances of unnecessary medical use and spend, and safer, more appropriate and cost-effective care.

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ALCA

MN FLLAMATX

CTKYMAOHOK

DETXRIWA

MNNYOKOR

AZCOMIMNNVOR

AKARDEHIINKYLAMD

AZCACTMAMENH

NCNJNVOHUTVAWA

NYPARITNVT

MT

Suboxone®

Embeda®

Nucynta IR®

Onsolis®

Abstral®

Butrans®

Conzip®

Exalgo®

Lazanda®

Nucynta® EROpana ER®*Subsys®

Zubzolv®

Zohydro® ER

Troxyca® ER

Xtampza® ER

Zohydro® ER*

Probuphine

Bunavail®

Embeda®*oxycodone ER (generic OxyContin®)

Xartemis XR®

Belbuca®

Hyslinga® ER*Oxaydo®

*OxyContin®*

RoxyBond™

Opana® ER*Arymo™ ER*

16

Opioid analgesic laws

Abbreviations: CE = Continuing Education MED = Morphine Equivalency Dose MME = Morphine Milligram Equivalent PDMP = Prescription Drug Monitoring Program

Connecticut House Bill 5053 House Bill 7052 (2017 and 2018)Effective January 1, 2017

• Restricts the issuing of an initial prescription for an opioid analgesic to more than a seven-day supply.

• Provides exemptions for cancer treatment or at the professional judgment of the physician, however, this must be documented in the patient's file.

• Enhances reporting requirements for both prescribers and dispensing pharmacies with the state PDMP program.

• Limits issuing a prescription for an opioid analgesic medication for the first time to a maximum supply of seven days (effective July 1, 2017).

• Requires insurance companies in the state to provide coverage for substance abuse disorder.

• Requires all prescriptions of controlled substances to be done via ePrescribing (effective January 1, 2018).

Delaware RegulationEffective April 1, 2017

• Limits first time prescriptions of an opioid analgesic to treat acute pain to no more than a seven-day supply unless reasoning is documented and prescriber checks the state PDMP program.

• For subsequent prescriptions to treat acute pain, the prescriber shall be required to perform an appropriate evaluation of the medical condition, secure an informed consent document and check the state PDMP program.

• When treating for chronic pain, the prescriber shall complete all requirements (established by the licensing board) and check the PDMP at least once every six months.

Arkansas Senate Bill 339Effective April 3, 2017

• Requires Arkansas State Licensing Boards to develop rules limiting the amount of Schedule II opioid analgesic being prescribed and dispensed by licensees of the various Boards.

• Enhances requirements for prescribers to check the state PDMP program each time they prescribe a Schedule II or III opioid analgesic and for the initial prescription of a Benzodiazepine.

Alaska House Bill 159Effective July 26, 2017

• Limits initial opioid analgesic prescriptions to a seven-day supply.

• Permits prescriptions exceeding a seven-day supply if physician determines it to be medically necessary or under certain conditions to treat chronic pain.

• Requires development of continuing education requirements on issues such as opioid analgesic use, addiction and pain management.

Hawaii Senate Bill 505Effective July 1, 2017

• Limits initial concurrent opioid analgesic and benzodiazepine supply to seven days.

• Creates rules around prescribing of opioid analgesics and requires further action by Department of Health.

Indiana Senate Bill 226Effective July 1, 2017

• Initial opioid analgesic prescriptions limited to a seven-day supply.

• Requires development of additional prescribing rules by various medical licensing boards.

Kentucky House Bill 333Effective June 29, 2017

• Requires the Kentucky Office of Drug Control Policy and State Licensing Boards to establish prescribing limits for controlled substances.

• Requires limits for prescribing of any Schedule II medication for acute pain to a three-day supply and includes exemptions for chronic pain and end-of-life care.

• Rule-making currently in process.

17



Maine Legislative Draft 1646 and Senate Paper 671Effective July 28, 2016 (some changes made by LD 1031 in 2017)

• Imposes a seven-day supply limit on opioid analgesics when used to treat acute pain and a 30-day prescribing limit on opioid analgesics when used to treat chronic pain but recognizes treatment of certain conditions and end-of-life exemptions.

• Requires prescribers to check the PDMP every 90 days when prescribing opioid analgesics and for the initial prescription of any opioid analgesic and benzodiazepine.

• Requires dispensing pharmacies to check the PDMP if the person presenting an opioid prescription is not a Maine resident.

• Mandates prescribers complete at least three hours of CE on the subject of pain treatment and opioid addiction over a two-year period.

Louisiana House Bill 192Effective August 1, 2017

• Limits issuance of a first-time opioid analgesic prescription for a claimant with an acute condition to no more than a seven-day supply.

• Contains exemptions permitted for longer dosage if documented and justified by prescribing physician.

Maryland House Bill 1432Effective May 25, 2017

• Requires prescribing of the lowest effective dose of opioid analgesics.

• Requires prescribing of opioid analgesics to treat chronic pain to be based on evidence-based clinical guidelines.

Massachusetts House Bill 4056Effective December 1, 2016

• Limits the prescribing time frame for an initial prescription of any opioid analgesic to seven days with exemptions for the physicians’ professional judgment or certain end-of-life condition care.

• Requires prescribers in certain circumstances to engage in addiction risk assessment of the claimant and have the claimant execute an opioid treatment agreement prior to prescribing.

• Requires various state licensing boards to develop educational programs for prescribers and dispensers regarding the dangers, risks, and how to handle opioid addiction and overdose situations.

Nevada Assembly Bill 474Effective January 1, 2018

• Defines and limits initial prescription for a controlled substance to treat acute pain to an amount intended to be used for 14 days.

• Requires a prescription treatment agreement for prescribing of any controlled substance for more than 30 days for treatment of pain.

• Enhances existing PDMP reporting requirements and requires various licensing boards to develop continuing education programs on prescribing of opioid analgesics and opioid addiction.

New Hampshire Regulation (Via HB 1423)

Effective January 1, 2017• Prior to prescribing an opioid analgesic for the

treatment of acute pain, a prescriber must conduct a physical examination of the claimant, complete a board approved risk assessment and provide a written rationale for the opioid usage. Prescribers are not to exceed an initial seven-day supply.

• Prior to treatment of chronic pain, prescribers shall complete the initial requirements and shall prescribe the lowest effective dose for a limited duration; some end-of-life care conditions are exempted.

• All prescribers must register with the state PDMP program and before initial prescribing of any Schedule II, III or IV opioid analgesic(s) they must query the program.

18

Ohio RegulationEffective August 31, 2017

• Limits initial prescriptions for acute pain opioid analgesics to a seven-day supply.

• Limits ongoing prescriptions for acute pain with opioid analgesics to no more than 30 MED per day average.

• Permits doctors to exceed seven day initial and ongoing 30 MED average, if documented.

Pennsylvania House Bill 1699, Senate Bill 1202, Senate Bill 1368 (2016)

• HB 1699 limits the prescribing of opioid analgesics to seven days for claimants in a hospital emergency room, urgent care facility or under observation status in a hospital. Exempts patients being treated for cancer related pain and requires physician to indicate a non-opioid analgesic medication was inappropriate for the claimant before prescribing the opioid analgesic.

• SB 1202 requires all dispensers and prescribers to be registered with the state PDMP program. Additionally all prescribers must query the PMDP prior to prescribing an opioid analgesic or benzodiazepine and modifies reporting time for dispensing pharmacies to now be by the end of the business day.

• SB 1368 requires development of safe opioid analgesic prescribing curriculum in Pennsylvania medical schools and CE requirements for prescribers.

New York Senate Bill 8139Effective July 22, 2016

• For initial treatment of acute pain, practitioners may not prescribe more than a seven-day supply of any Schedule II, III or IV opioid analgesic; subsequent refills are subject to current prescribing limitations under law.

• Requires pharmacists to provide approved educational materials to a claimant when dispensing a controlled substance which must meet minimum requirements informing the patient of the risks of using a controlled substance.

• Implements new training requirements for medical professionals, including physicians and pharmacists on the practice of pain management, palliative care and addiction.

New Jersey Senate Bill 3Effective May 16, 2017

• Requires health insurers to provide benefits for substance abuse disorders.

• Limits the initial opioid analgesic prescription to a five-day supply for acute pain.

North Carolina House Bill 243Signed by Governor, Multiple Effective Dates

• Defines both acute and chronic pain.

• Limits prescriptions upon initial consultation for acute pain to more than a five-day supply of any targeted controlled substance.

• Makes additional enhancements to state PDMP program reporting requirements as well as requirements for ePrescribing of controlled substances.



Rhode Island House Bill 8224Effective June 28, 2016

• Limits initial prescriptions of opioid analgesics for acute pain to not exceed 30 MME total daily dose per day for a maximum of 20 days with exemptions for chronic pain under certain medical conditions.

• Mandates registration with the state PDMP program upon initial or renewal licensure application.

• Requires prescribers to review the state PDMP before starting any opioid analgesic therapy and at least once every three months for ongoing therapy. Pharmacies shall also report the dispensing of any opioid within one business day.

19



Utah House Bill 50Effective July 23, 2017

• Limits the prescribing of opioid analgesics (for workers’ compensation, auto and general health claimants) to seven days for acute conditions.

• Exempts pain related to surgery and the physician believes the seven-day supply is not adequate, the physician can prescribe up to 30 days. Also exempts certain documented chronic conditions.

• Requires prescribers to check the state PDMP program prior to dispensing the first fill of any opioid analgesic which exceeds three days or is not associated with surgery.

Vermont Regulation (Via SB 243)Effective July 1, 2017

• Provides full and clear definitions of acute and chronic pain and establishes treatment protocols with daily MME dosage levels for both.

• Categorizes acute pain into four specific levels of pain and establishes a ceiling of 50 MME/day for a seven-day supply of opioid analgesics.

• Defines chronic pain as pain lasting greater than 90 days and requires the prescriber to complete a medical examination and establishes a ceiling of 90 MME/day for treatment.

Virginia RegulationEffective September 14, 2017

• Initiation of opioid treatment for acute pain shall be with short-acting opioids and shall not exceed a seven-day supply.

• Prior to initiating treatment with a controlled substance containing an opioid, prescribers must query the state PDMP program.

• Requires prescribers to follow specific protocols when initiating treatment of chronic pain including UDM, developing a treatment plan and a query of the state PDMP program.

Washington House Bill 1427Effective July 23, 2017

• Requires rule development by various medical licensing boards regarding opioid analgesic prescription restrictions.

20

Brand-Generic Index

Brand Generic Therapeutic Class Pharmaceutical Uses†

Abilify® aripiprazole Antipsychotic Schizophrenia/Bipolar Disorder/Depression

Aciphex® rabeprazole Ulcer Drug Ulcers/GERD

Adderall® amphetamine/dextroamphetamine Stimulant Attention Deficit Hyperactivity Disorder

Advair Diskus® fluticasone/salmeterol Antiasthmatic Asthma/COPD

Advil® ibuprofen NSAID Pain/Inflammation

Altace® ramipril Antihypertensive High Blood Pressure/Heart Failure

Ambien CR® zolpidem ER Hypnotic Insomnia

Ambien® zolpidem Hypnotic Insomnia

Amitiza® lubiprostone Gastrointestinal Agent Constipation/Opioid-Induced Constipation

Amrix® cyclobenzaprine ER Skeletal Muscle Relaxant Muscle Spasm

Anaprox® DS naproxen sodium NSAID Pain/Inflammation

Androgel® testosterone Androgen Testosterone Deficiency

Antivert® meclizine Antiemetic Nausea/Vomiting

Arthrotec® diclofenac/misoprostol NSAID Pain/Inflammation

Arymo® ER morphine ER Opioid Analgesic Pain

Atarax® hydroxyzine Antianxiety Agent Anxiety/Itching

Ativan® lorazepam Antianxiety Agent Anxiety/Insomnia

Augmentin® amoxicillin/clavulanate potassium Antibiotic Bacterial Infections

Avinza® morphine ER Opioid Analgesic Pain

Bactrim® DS sulfamethoxazole/trimethoprim Antibiotic Bacterial Infections

Bactroban® mupirocin Antiinfective - Topical Skin Infections

BuSpar® buspirone Antianxiety Agent Anxiety

Butrans® buprenorphine Opioid Analgesic Pain

Bystolic® nebivolol Antihypertensive High Blood Pressure

Cataflam® diclofenac potassium NSAID Pain/Inflammation

Catapres® clonidine Antihypertensive High Blood Pressure

Celebrex® celecoxib NSAID Pain/Inflammation

Celexa® citalopram Antidepressant Depression

Cialis® tadalafil Misc Cardiovascular Erectile Dysfunction/Enlarged Prostate

Cipro® ciprofloxacin Antibiotic Bacterial Infections

Cleocin® clindamycin Antibiotic Bacterial Infections

Clinoril® sulindac NSAID Pain/Inflammation

Colace® docusate sodium Laxative Constipation

Combivent® Respimat® ipratropium bromide/albuterol Antiasthmatic COPD

Constulose® lactulose Laxative Constipation

Conzip® tramadol ER Opioid Analgesic Pain

Coreg® carvedilol Antihypertensive High Blood Pressure/Heart Failure

Coumadin® warfarin Anticoagulant Blood Thinner

Cozaar® losartan potassium Antihypertensive High Blood Pressure

Crestor® rosuvastatin Antihyperlipidemic High Cholesterol

Cymbalta® duloxetine Antidepressant Depression/Pain/Anxiety

† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease

21

Brand-Generic Index


Daypro® oxaprozin NSAID Pain/Inflammation

Deltasone® prednisone Corticosteroid Inflammatory Disorders

Depakote® divalproex Anticonvulsant Seizures/Migraine/Bipolar Disorder

Depakote® ER divalproex ER Anticonvulsant Seizures/Migraine/Bipolar Disorder

Desyrel® trazodone Antidepressant Depression/Insomnia

Dexilant™ dexlansoprazole Ulcer Drug Ulcers/GERD

Dilantin® phenytoin Anticonvulsant Seizures

Dilaudid® hydromorphone Opioid Analgesic Pain

Diovan® valsartan Antihypertensive High Blood Pressure/Heart Failure

Ditropan XL® oxybutynin ER Urinary Antispasmodic Overactive Bladder

Dolophine® methadone Opioid Analgesic Pain

Duexis® ibuprofen/famotidine NSAID/Histamine Blocker Arthritis/Ulcer Risk Reduction

Dulcolax® Suppository bisacodyl Laxative Constipation

Duragesic® fentanyl Opioid Analgesic Pain

EC-Naprosyn® naproxen delayed-release NSAID Pain/Inflammation

Ecotrin® aspirin Non-Opioid Analgesic Pain/Inflammation/Fever

Effexor® venlafaxine Antidepressant Depression

Effexor® XR venlafaxine ER Antidepressant Depression

Elavil® amitriptyline Antidepressant Depression/Insomnia/Nerve Pain

Eliquis® apixaban Anticoagulant Blood Thinner

Embeda® morphine/naltrexone Opioid Analgesic Pain

Esgic®/Fioricet® butalbital/acetaminophen/caffeine Non-Opioid Analgesic Headache

Exalgo® hydromorphone ER Opioid Analgesic Pain

Feldene® piroxicam NSAID Pain/Inflammation

Flector® Patch diclofenac patch Topical NSAID Pain/Inflammation

Flexeril® cyclobenzaprine Skeletal Muscle Relaxant Muscle Spasm

Flomax® tamsulosin Misc Genitourinary Product Enlarged Prostate

Flonase® fluticasone Corticosteroid - Nasal Allergies

Glucophage® metformin Antidiabetic High Blood Sugar

Gralise® gabapentin Anticonvulsant Nerve Pain

Horizant® gabapentin enacarbil Anticonvulsant Restless Legs Syndrome

Hydrodiuril® hydrochlorothiazide Diuretic High Blood Pressure/Heart Failure

Hysingla® ER hydrocodone ER Opioid Analgesic Pain

Imitrex® sumatriptan Migraine Product Migraine

Inderal® propranolol Antihypertensive High Blood Pressure/Migraine

Inderal® LA propranolol ER Antihypertensive High Blood Pressure/Migraine

Isentress® raltegravir Antiviral Human Immunodeficiency Virus Infection

Kadian® morphine ER Opioid Analgesic Pain

Keflex® cephalexin Antibiotic Bacterial Infections

Kenalog® triamcinolone Corticosteroid - Topical Inflammatory Disorders

Keppra® levetiracetam Antianxiety Agent Seizures

Klonopin® clonazepam Anticonvulsant Seizures/Panic Disorder


22

Brand-Generic Index


Klor-Con® potassium chloride Mineral & Electrolyte Potassium Deficiency

Lamictal® lamotrigine Anticonvulsant Seizures/Bipolar Disorder

Lasix® furosemide Diuretic High Blood Pressure/Heart Failure

Levaquin® levofloxacin Antibiotic Bacterial Infections

Lexapro® escitalopram Antidepressant Depression

Lidoderm® Patch lidocaine patch Topical Analgesic - Anesthetic Nerve Pain

Linzess® linaclotide Gastrointestinal Agent Constipation/Irritable Bowel Syndrome

Lioresal® baclofen Skeletal Muscle Relaxant Spasticity

Lipitor® atorvastatin Antihyperlipidemic High Cholesterol

Lodine® etodolac NSAID Pain/Inflammation

Lodine® ER etodolac ER NSAID Pain/Inflammation

Lopressor® metoprolol tartrate Antihypertensive High Blood Pressure/Angina

Lovenox® enoxaparin Anticoagulant Blood Thinner

Lunesta® eszopiclone Hypnotic Insomnia

Lyrica® pregabalin Anticonvulsant Fibromyalgia/Seizures/Nerve Pain

Medrol® methylprednisolone Corticosteroid Inflammatory Disorders

Minipress® prazosin Antihypertensive High Blood Pressure

MiraLAX® polyethylene glycol Laxative Constipation

Mobic® meloxicam NSAID Pain/Inflammation

Movantik® naloxegol Gastrointestinal Agent Opioid-Induced Constipation

Moxatag® amoxicillin ER Antibiotic Bacterial Infections

MS Contin® morphine ER Opioid Analgesic Pain

Naprosyn® naproxen NSAID Pain/Inflammation

Neurontin® gabapentin Anticonvulsant Seizures/Nerve Pain

New Terocin Lotion methyl salicylate/capsaicin/menthol Dermatological - Topical Topical Pain Relief

Nexium® esomeprazole magnesium Ulcer Drug Ulcers/GERD

Norco® hydrocodone/acetaminophen Opioid Analgesic Pain

Norflex® orphenadrine Skeletal Muscle Relaxant Muscle Spasm

Norvasc® amlodipine Antihypertensiver High Blood Pressure/Angina

Nucynta® tapentadol Opioid Analgesic Pain

Nucynta® ER tapentadol ER Opioid Analgesic Pain

Nuvigil® armodafinil Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder

Opana® oxymorphone Opioid Analgesic Pain

Orudis® ketoprofen NSAID Pain/Inflammation

OxyContin® oxycodone ER Opioid Analgesic Pain

Pamelor® nortriptyline Antidepressant Depression/Insomnia/Nerve Pain

Parafon Forte® DSC chlorzoxazone Skeletal Muscle Relaxant Muscle Spasm

Paxil® paroxetine Antidepressant Depression

Pennsaid® Solution diclofenac solution Topical NSAID Pain/Inflammation

Pepcid® famotidine Ulcer Drug Ulcers/GERD

Percocet® oxycodone/acetaminophen Opioid Analgesic Pain

Phenergan® promethazine Antihistamine Nausea/Vomiting


23

Brand-Generic Index


Plavix® clopidogrel Hematological Post Stroke/Heart Attack

Pred Forte® prednisolone Ophthalmic Eye Inflammation

Prevacid® lansoprazole Ulcer Drug Ulcers/GERD

Prilosec® omeprazole Ulcer Drug Ulcers/GERD

Pristiq® desvenlafaxine ER Antidepressant Depression

ProAir® HFA albuterol sulfate Antiasthmatic Asthma

Protonix® pantoprazole Ulcer Drug Ulcers/GERD

Provigil® modafinil Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder

Prozac® fluoxetine Antidepressant Depression

Relafen® nabumetone NSAID Pain/Inflammation

Remeron® mirtazapine Antidepressant Depression

Requip® ropinirole Antiparkinsonian Parkinson's Disease/Restless Legs Syndrome

Restoril™ temazepam Hypnotic Insomnia

Risperdal® risperidone Antipsychotic Schizophrenia/Bipolar Disorder

Ritalin® methylphenidate Stimulant Attention Deficit Hyperactivity Disorder

Robaxin® methocarbamol Skeletal Muscle Relaxant Muscle Spasm

Roxicodone® oxycodone Opioid Analgesic Pain

Senokot® sennosides Laxative Constipation

Senokot-S® senna/docusate sodium Laxative Constipation

Seroquel XR® quetiapine ER Antipsychotic Schizophrenia/Bipolar Disorder/Depression

Seroquel® quetiapine Antipsychotic Schizophrenia/Bipolar Disorder

Silvadene® silver sulfadiazine Antiinfective - Topical Burn Wound

Sinequan® doxepin Antidepressant Depression/Insomnia

Singulair® montelukast Antiasthmatic Asthma/Allergic Rhinitis

Skelaxin® metaxalone Skeletal Muscle Relaxant Muscle Spasm

Soma® carisoprodol Skeletal Muscle Relaxant Muscle Spasm

Spiriva® Handihaler® tiotropium Antiasthmatic COPD

Suboxone® buprenorphine/naloxone Opioid Analgesic Opioid dependence

Subutex® buprenorphine Opioid Analgesic Opioid dependence

Symbicort® budesonide/formoterol Antiasthmatic Asthma/COPD

Synthroid® levothyroxine Thyroid Thyroid Hormone Deficiency

Tegretol® carbamazepine Anticonvulsant Seizures/Bipolar Disorder/Nerve Pain

Tenormin® atenolol Antihypertensive High Blood Pressure/Angina

Terocin Patch lidocaine/menthol Dermatological - Topical Topical Pain Relief

Tivorbex® indomethacin NSAID Pain/Inflammation

Topamax® topiramate Anticonvulsant Seizures/Migraine

Toprol-XL® metoprolol ER Antihypertensive High Blood Pressure/Heart Failure/Angina

Toradol® ketorolac NSAID Pain/Inflammation

Tricor® fenofibrate Antihyperlipidemic High Cholesterol

Trileptal® oxcarbazepine Anticonvulsant Seizures

Trintellix® vortioxetine Antidepressant Depression

Truvada® emtricitabine/tenofovir Antiviral Human Immunodeficiency Virus Infection


24


Tylenol® Extra Strength acetaminophen extra-strength Non-Opioid Analgesic Pain/Fever

Tylenol® with Codeine #3

acetaminophen/codeine Opioid Analgesic Pain

Ultracet® tramadol/acetaminophen Opioid Analgesic Pain

Ultram® tramadol Opioid Analgesic Pain

Ultram® ER tramadol ER Opioid Analgesic Pain

Valium® diazepam Antianxiety Agent Anxiety/Muscle spasms

Ventolin®/Proventil® albuterol nebulizer solution Antiasthmatic Asthma

Viagra® sildenafil Misc Cardiovascular Erectile Dysfunction/Pulmonary Hypertension

Vibramycin® doxycycline hyclate Antibiotic Bacterial Infections

Vicoprofen® hydrocodone/ibuprofen Opioid Analgesic Pain

Viibryd® vilazodone Antidepressant Depression

Vimovo® naproxen/esomeprazole NSAID/Proton Pump Inhibitor Arthritis/Ulcer Risk Reduction

Vistaril® hydroxyzine pamoate Antianxiety Agent Anxiety/Itching

Voltaren® diclofenac NSAID Pain/Inflammation

Voltaren® Gel diclofenac gel Topical NSAID Pain/Inflammation

Voltaren®-XR diclofenac ER NSAID Pain/Inflammation

Wellbutrin XL® bupropion ER Antidepressant Depression

Wellbutrin® bupropion Antidepressant Depression

Xanax® alprazolam Antianxiety Agent Anxiety/Panic Disorder

Xarelto® rivaroxaban Anticoagulant Blood Thinner

Xylocaine® lidocaine ointment Dermatological - Topical Numbing/Nerve Pain

Zanaflex® tizanidine Skeletal Muscle Relaxant Muscle Spasm

Zantac® ranitidine Ulcer Drug Ulcers/GERD

Zestril® lisinopril Antihypertensive High Blood Pressure/Heart Failure

Zetia® ezetimibe Antihyperlipidemic High Cholesterol

Zipsor® diclofenac potassium NSAID Pain/Inflammation

Zithromax® azithromycin Antibiotic Bacterial Infections

Zocor® simvastatin Antihyperlipidemic High Cholesterol

Zofran® ondansetron Antiemetic Nausea/Vomiting

Zoloft® sertraline Antidepressant Depression

Zonegran® zonisamide Anticonvulsant Seizures

Zorvolex® diclofenac NSAID Pain/Inflammation

Zyprexa® olanzapine Antipsychotic Schizophrenia/Bipolar Disorder/Depression

Brand-Generic Index

DISCLAIMERS: The information is provided AS IS, for informational purposes only, and is not intended to constitute medical advice or to be used for diagnostic or treatment purposes. Optum does not warrant or guarantee the accuracy of this information and is not responsible for any results obtained from its use. Contact a physician or other health care provider before taking any medical action based on this information, including changes to medication therapy. Readers are encouraged to confirm information independently and/or consult with their legal representatives.NOTE: Company and product names mentioned are either registered trademarks or trademarks of their respective users. Some brand name products are no longer on the market. Furthermore, if a generic medication is commercially available, not all strengths may have a generic equivalent.


25

Generic-Brand Index

Generic Brand Therapeutic Class Pharmaceutical Uses†

acetaminophen extra-strength Tylenol® Extra Strength Non-Opioid Analgesic Pain/Fever

acetaminophen/codeine Tylenol® with Codeine #3 Opioid Analgesic Pain

albuterol nebulizer solution Ventolin®/Proventil® Antiasthmatic Asthma

albuterol sulfate ProAir® HFA Antiasthmatic Asthma

alprazolam Xanax® Antianxiety Agent Anxiety/Panic Disorder

amitriptyline Elavil® Antidepressant Depression/Insomnia/Nerve Pain

amlodipine Norvasc® Antihypertensive High Blood Pressure/Angina

amoxicillin ER Moxatag® Antibiotic Bacterial Infections

amoxicillin/ clavulanate potassium

Augmentin® Antibiotic Bacterial Infections

amphetamine/ dextroamphetamine

Adderall® Stimulant Attention Deficit Hyperactivity Disorder

apixaban Eliquis® Anticoagulant Blood Thinner

aripiprazole Abilify® Antipsychotic Schizophrenia/Bipolar Disorder/Depression

armodafinil Nuvigil® Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder

aspirin Ecotrin® Non-Opioid Analgesic Pain/Inflammation/Fever

atenolol Tenormin® Antihypertensive High Blood Pressure/Angina

atorvastatin Lipitor® Antihyperlipidemic High Cholesterol

azithromycin Zithromax® Antibiotic Bacterial Infections

baclofen Lioresal® Skeletal Muscle Relaxant Spasticity

bisacodyl Dulcolax® Suppository Laxative Constipation

budesonide/formoterol Symbicort® Antiasthmatic Asthma/COPD

buprenorphine Butrans® Opioid Analgesic Pain

buprenorphine Subutex® Opioid Analgesic Opioid dependence

buprenorphine/naloxone Suboxone® Opioid Analgesic Opioid dependence

bupropion Wellbutrin® Antidepressant Depression

bupropion ER Wellbutrin XL® Antidepressant Depression

buspirone BuSpar® Antianxiety Agent Anxiety

butalbital/acetaminophen/ caffeine

Esgic®/Fioricet® Non-Opioid Analgesic Headache

carbamazepine Tegretol® Anticonvulsant Seizures/Bipolar Disorder/Nerve Pain

carisoprodol Soma® Skeletal Muscle Relaxant Muscle Spasm

carvedilol Coreg® Antihypertensive High Blood Pressure/Heart Failure

celecoxib Celebrex® NSAID Pain/Inflammation

cephalexin Keflex® Antibiotic Bacterial Infections

chlorzoxazone Parafon Forte® DSC Skeletal Muscle Relaxant Muscle Spasm

ciprofloxacin Cipro® Antibiotic Bacterial Infections

citalopram Celexa® Antidepressant Depression

clindamycin Cleocin® Antibiotic Bacterial Infections

clonazepam Klonopin® Anticonvulsant Antianxiety Agent

clonidine Catapres® Antihypertensive High Blood Pressure

clopidogrel Plavix® Hematological Post Stroke/Heart Attack

cyclobenzaprine Flexeril® Skeletal Muscle Relaxant Muscle Spasm


26


cyclobenzaprine ER Amrix® Skeletal Muscle Relaxant Muscle Spasm

desvenlafaxine ER Pristiq® Antidepressant Depression

dexlansoprazole Dexilant™ Ulcer Drug Ulcers/GERD

diazepam Valium® Antianxiety Agent Anxiety/Muscle spasms

diclofenac potassium Cataflam® NSAID Pain/Inflammation

diclofenac Voltaren® NSAID Pain/Inflammation

diclofenac Zorvolex® NSAID Pain/Inflammation

diclofenac ER Voltaren®-XR NSAID Pain/Inflammation

diclofenac gel Voltaren® Gel Topical NSAID Pain/Inflammation

diclofenac patch Flector® Patch Topical NSAID Pain/Inflammation

diclofenac potassium Zipsor® NSAID Pain/Inflammation

diclofenac solution Pennsaid® Solution Topical NSAID Pain/Inflammation

diclofenac/misoprostol Arthrotec® NSAID Pain/Inflammation

divalproex Depakote® Anticonvulsant Seizures/Migraine/Bipolar Disorder

divalproex ER Depakote® ER Anticonvulsant Seizures/Migraine/Bipolar Disorder

docusate sodium Colace® Laxative Constipation

doxepin Sinequan® Antidepressant Depression/Insomnia

doxycycline hyclate Vibramycin® Antibiotic Bacterial Infections

duloxetine Cymbalta® Antidepressant Depression/Pain/Anxiety

emtricitabine/tenofovir Truvada® Antiviral Human Immunodeficiency Virus Infection

enoxaparin Lovenox® Anticoagulant Blood Thinner

escitalopram Lexapro® Antidepressant Depression

esomeprazole magnesium Nexium® Ulcer Drug Ulcers/GERD

eszopiclone Lunesta® Hypnotic Insomnia

etodolac Lodine® NSAID Pain/Inflammation

etodolac ER Lodine® ER NSAID Pain/Inflammation

ezetimibe Zetia® Antihyperlipidemic High Cholesterol

famotidine Pepcid® Ulcer Drug Ulcers/GERD

fenofibrate Tricor® Antihyperlipidemic High Cholesterol

fentanyl Duragesic® Opioid Analgesic Pain

fluoxetine Prozac® Antidepressant Depression

fluticasone Flonase® Corticosteroid - Nasal Allergies

fluticasone/salmeterol Advair Diskus® Antiasthmatic Asthma/COPD

furosemide Lasix® Diuretic High Blood Pressure/Heart Failure

gabapentin Neurontin® Anticonvulsant Seizures/Nerve Pain

gabapentin Gralise® Anticonvulsant Nerve Pain

gabapentin enacarbil Horizant® Anticonvulsant Restless Legs Syndrome

hydrochlorothiazide Hydrodiuril® Diuretic High Blood Pressure/Heart Failure

hydrocodone ER Hysingla® ER Opioid Analgesic Pain

hydrocodone/acetaminophen Norco® Opioid Analgesic Pain

hydrocodone/ibuprofen Vicoprofen® Opioid Analgesic Pain

hydromorphone Dilaudid® Opioid Analgesic Pain

Generic-Brand Index


27


hydromorphone ER Exalgo® Opioid Analgesic Pain

hydroxyzine Atarax® Antianxiety Agent Anxiety/Itching

hydroxyzine pamoate Vistaril® Antianxiety Agent Anxiety/Itching

ibuprofen Advil® NSAID Pain/Inflammation

ibuprofen/famotidine Duexis® NSAID/Histamine Blocker Arthritis/Ulcer Risk Reduction

indomethacin Tivorbex® NSAID Pain/Inflammation

ipratropium bromide/albuterolCombivent® Respimat® Antiasthmatic COPD

ketoprofen Orudis® NSAID Pain/Inflammation

ketorolac Toradol® NSAID Pain/Inflammation

lactulose Constulose® Laxative Constipation

lamotrigine Lamictal® Anticonvulsant Seizures/Bipolar Disorder

lansoprazole Prevacid® Ulcer Drug Ulcers/GERD

levetiracetam Keppra® Anticonvulsant Seizures

levofloxacin Levaquin® Antibiotic Bacterial Infections

levothyroxine Synthroid® Thyroid Thyroid Hormone Deficiency

lidocaine ointment Xylocaine® Dermatological - Topical Numbing/Nerve Pain

lidocaine patch Lidoderm® Patch Topical Analgesic - Anesthetic Nerve Pain

lidocaine/menthol Terocin Patch Dermatological - Topical Topical Pain Relief

linaclotide Linzess® Gastrointestinal Agent Constipation/Irritable Bowel Syndrome

lisinopril Zestril® Antihypertensive High Blood Pressure/Heart Failure

lorazepam Ativan® Antianxiety Agent Anxiety/Insomnia

losartan potassium Cozaar® Antihypertensive High Blood Pressure

lubiprostone Amitiza® Gastrointestinal Agent Constipation/Opioid-Induced Constipation

meclizine Antivert® Antiemetic Nausea/Vomiting

meloxicam Mobic® NSAID Pain/Inflammation

metaxalone Skelaxin® Skeletal Muscle Relaxant Muscle Spasm

metformin Glucophage® Antidiabetic High Blood Sugar

methadone Dolophine® Opioid Analgesic Pain

methocarbamol Robaxin® Skeletal Muscle Relaxant Muscle Spasm

methyl salicylate/ capsaicin/menthol

New Terocin Lotion Dermatological - Topical Topical Pain Relief

methylphenidate Ritalin® Stimulant Attention Deficit Hyperactivity Disorder

methylprednisolone Medrol® Corticosteroid Inflammatory Disorders

metoprolol ER Toprol-XL® Antihypertensive High Blood Pressure/Heart Failure/Angina

metoprolol tartrate Lopressor® Antihypertensive High Blood Pressure/Angina

mirtazapine Remeron® Antidepressant Depression

modafinil Provigil® Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder

montelukast Singulair® Antiasthmatic Asthma/Allergic Rhinitis

morphine ER Arymo® ER Opioid Analgesic Pain

morphine ER Avinza® Opioid Analgesic Pain

morphine ER Kadian® Opioid Analgesic Pain

morphine ER MS Contin® Opioid Analgesic Pain

Generic-Brand Index


28


morphine/naltrexone Embeda® Opioid Analgesic Pain

mupirocin Bactroban® Antiinfective - Topical Skin Infections

nabumetone Relafen® NSAID Pain/Inflammation

naloxegol Movantik® Gastrointestinal Agent Opioid-Induced Constipation

naproxen Naprosyn® NSAID Pain/Inflammation

naproxen delayed-release EC-Naprosyn® NSAID Pain/Inflammation

naproxen sodium Anaprox® DS NSAID Pain/Inflammation

naproxen/esomeprazole Vimovo® NSAID/Proton Pump Inhibitor Arthritis/Ulcer Risk Reduction

nebivolol Bystolic® Antihypertensive High Blood Pressure

nortriptyline Pamelor® Antidepressant Depression/Insomnia/Nerve Pain

olanzapine Zyprexa® Antipsychotic Schizophrenia/Bipolar Disorder/Depression

omeprazole Prilosec® Ulcer Drug Ulcers/GERD

ondansetron Zofran® Antiemetic Nausea/Vomiting

orphenadrine Norflex® Skeletal Muscle Relaxant Muscle Spasm

oxaprozin Daypro® NSAID Pain/Inflammation

oxcarbazepine Trileptal® Anticonvulsant Seizures

oxybutynin ER Ditropan XL® Urinary Antispasmodic Overactive Bladder

oxycodone Roxicodone® Opioid Analgesic Pain

oxycodone ER OxyContin® Opioid Analgesic Pain

oxycodone/acetaminophen Percocet® Opioid Analgesic Pain

oxymorphone Opana® Opioid Analgesic Pain

pantoprazole Protonix® Ulcer Drug Ulcers/GERD

paroxetine Paxil® Antidepressant Depression

phenytoin Dilantin® Anticonvulsant Seizures

piroxicam Feldene® NSAID Pain/Inflammation

polyethylene glycol MiraLAX® Laxative Constipation

potassium chloride Klor-Con® Mineral & Electrolyte Potassium Deficiency

prazosin Minipress® Antihypertensive High Blood Pressure

prednisolone Pred Forte® Ophthalmic Eye Inflammation

prednisone Deltasone® Corticosteroid Inflammatory Disorders

pregabalin Lyrica® Anticonvulsant Fibromyalgia/Seizures/Nerve Pain

promethazine Phenergan® Antihistamine Nausea/Vomiting

propranolol Inderal® Antihypertensive High Blood Pressure/Migraine

propranolol ER Inderal® LA Antihypertensive High Blood Pressure/Migraine

quetiapine Seroquel® Antipsychotic Schizophrenia/Bipolar Disorder

quetiapine ER Seroquel XR® Antipsychotic Schizophrenia/Bipolar Disorder/Depression

rabeprazole Aciphex® Ulcer Drug Ulcers/GERD

raltegravir Isentress® Antiviral Human Immunodeficiency Virus Infection

ramipril Altace® Antihypertensive High Blood Pressure/Heart Failure

ranitidine Zantac® Ulcer Drug Ulcers/GERD

risperidone Risperdal® Antipsychotic Schizophrenia/Bipolar Disorder

rivaroxaban Xarelto® Anticoagulant Blood Thinner

Generic-Brand Index


29

Generic-Brand Index


ropinirole Requip® Antiparkinsonian Parkinson's Disease/Restless Legs Syndrome

rosuvastatin Crestor® Antihyperlipidemic High Cholesterol

senna/docusate sodium Senokot-S® Laxative Constipation

sennosides Senokot® Laxative Constipation

sertraline Zoloft® Antidepressant Depression

sildenafil Viagra® Misc Cardiovascular Erectile Dysfunction/Pulmonary Hypertension

silver sulfadiazine Silvadene® Antiinfective - Topical Burn Wound

simvastatin Zocor® Antihyperlipidemic High Cholesterol

sulfamethoxazole/ trimethoprim

Bactrim® DS Antibiotic Bacterial Infections

sulindac Clinoril® NSAID Pain/Inflammation

sumatriptan Imitrex® Migraine Product Migraine

tadalafil Cialis® Misc Cardiovascular Erectile Dysfunction/Enlarged Prostate

tamsulosin Flomax® Misc Genitourinary Product Enlarged Prostate

tapentadol Nucynta® Opioid Analgesic Pain

tapentadol ER Nucynta® ER Opioid Analgesic Pain

temazepam Restoril™ Hypnotic Insomnia

testosterone Androgel® Androgen Testosterone Deficiency

tiotropium Spiriva® Handihaler® Antiasthmatic COPD

tizanidine Zanaflex® Skeletal Muscle Relaxant Muscle Spasm

topiramate Topamax® Anticonvulsant Seizures/Migraine

tramadol Ultram® Opioid Analgesic Pain

tramadol ER Conzip® Opioid Analgesic Pain

tramadol ER Ultram® ER Opioid Analgesic Pain

tramadol/acetaminophen Ultracet® Opioid Analgesic Pain

trazodone Desyrel® Antidepressant Depression/Insomnia

triamcinolone Kenalog® Corticosteroid - Topical Inflammatory Disorders

valsartan Diovan® Antihypertensive High Blood Pressure/Heart Failure

venlafaxine Effexor® Antidepressant Depression

venlafaxine ER Effexor® XR Antidepressant Depression

vilazodone Viibryd® Antidepressant Depression

vortioxetine Trintellix® Antidepressant Depression

warfarin Coumadin® Anticoagulant Blood Thinner

zolpidem Ambien® Hypnotic Insomnia

zolpidem ER Ambien CR® Hypnotic Insomnia

zonisamide Zonegran® Anticonvulsant Seizures

DISCLAIMERS: The information is provided AS IS, for informational purposes only, and is not intended to constitute medical advice or to be used for diagnostic or treatment purposes. Optum does not warrant or guarantee the accuracy of this information and is not responsible for any results obtained from its use. Contact a physician or other health care provider before taking any medical action based on this information, including changes to medication therapy. Readers are encouraged to confirm information independently and/or consult with their legal representatives.NOTE: Company and product names mentioned are either registered trademarks or trademarks of their respective users. Some brand name products are no longer on the market. Furthermore, if a generic medication is commercially available, not all strengths may have a generic equivalent.


30

Drug overdoses are now responsible for more deaths than car accidents.We commonly see estimates of around 4.5 million people suffering from opioid analgesic abuse, recent estimates indicate more than 5 million Americans suffer from prescription pain killer addictions.

Five opioid risk management strategies1. Prevention and education2. Minimizing early exposure3. Reducing inappropriate supply4. Treating the at-risk and high-risk5. Supporting chronic populations and those in recovery

Nationwide, opioid analgesic abuse costs employers an estimated

$25.5 billion a year in missed workdays

and lost productivity.

3,900people initiate non-medical use of opioid analgesics

580people initiate heroin use

78people die from an opioid-related overdose

650,000opioid analgesic prescriptions are dispensed

More than

Drug overdose is the leading cause of accidental death in the US, with

lethal drug overdoses in 2015.

Opioid analgesic addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.

52,404

The 2013 and 2014 National Survey on Drug Use and Health (NSDUH) found that

of people misusing prescription painkillers got them from a friend or relative for free.

50.5%

It is estimated between

and between

of claimants with chronic pain end up misusing medications

become addicted to them

21% and 29%

8% and 12%

people are treated in emergency departments for not using opioid analgesics as directed.

Each day more than

1,000

25 to 54Overdose rates were highest among people aged

of all workers’ compensation costs

are related to opioid analgesics25%

of patients who survive overdose

are prescribed more opioid analgesics91%

dispensed in the world are dispensed in the U.S.

of all opioid analgesics80%

12% declinein opioid analgesic prescriptions, after a peak in 2012.

For the first time, 2016 saw a

On an average day in the U.S.

31

2017. Available at: https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. Accessed August 17, 2017.

LiveScience Facts About Opioids — Hydrocodone, Oxycodone, Codeine & Others. Live Science. 2017. Available at: https://www.livescience.com/53856-opioid-facts.html. Accessed August 17, 2017.

Steven A. King M. 10 Opioid Myths and Facts | Psychiatric Times. Psychiatrictimes.com. December 16, 2016. Available at: http://www.psychiatrictimes.com/special-report/10-opioid-myths-and-facts. Accessed August 17, 2017.

Annual Review of Public Health. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Vol. 36: 559-574 (March 2015). Accessed at: http://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031914-122957 on September 28, 2016.

Opioid Factsheet. HHS.gov US Department of Health & Human Services. 2017. Available at: https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf. Accessed August 17, 2017.

Goodnough, A., & Tavernise, S. (2016, May 20). Opioid Prescriptions Drop for First Time in Two Decades. New York Times. Retrieved February 24, 2017, from https://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html

Mole, Beth. “91% of patients who survive opioid overdose are prescribed more opioids.” Ar Technica

Prescription Opioid Overdose Data | Drug Overdose | CDC Injury Center. Cdcgov. 2017. Available at: https://www.cdc.gov/drugoverdose/data/overdose.html. Accessed August 17, 2017.

Meinert, D. (2016, March 1). Combatting the Prescription Drug Crisis. HR Today.

Sources

About Optum Worker’s Comp and Auto No-fault Solutions

Optum Workers’ Comp and Auto No-fault Solutions collaborates with clients to lower costs while improving health outcomes for the claimants we serve. Our comprehensive pharmacy, ancillary and managed care services, including settlement solutions, combine data, analytics, and extensive clinical expertise with innovative technology to ensure claimants receive safe, efficacious and cost-effective care throughout the lifecycle of a claim. For more information, email us at [email protected].

Optum and its respective marks are trademarks of Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer.

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