Cubic News

Drug plans or dealer supply chains?

June 2011

While many people are aware of the abuse and misuse of prescription narcotic medications through various reports in news media, most do not realize or consider that employer-sponsored drug plans may be footing the bill for these practices.  In fact, the ease of narcotic abuse in drug plans is very concerning.

 Take the following example from an analysis we recently completed:

 In one year alone, narcotic drug claims for ‘Claimant A’ included the following:

• 9,492 tablets of OxyContin® 40mg (a 12-hour sustained-release formulation of oxycodone,  a potent narcotic generally taken twice a day and occasionally up to three times a day for instances of severe pain)
• 4,284 tablets of Endocet® (an immediate-release combination-oxycodone product)
• These quantities translate into 26 OxyContin® and 12 Endocet® tablets every single day of the year if this individual were to have consumed the entire supply paid by his/her drug plan.

Cases like the one above are concerning for obvious reasons:

• The quantities received by this individual represent an astronomically high daily dose, even for “catastrophic” conditions such as Rheumatoid Arthritis, Multiple Sclerosis or cancer, which can require extensive pain management. 
  • Furthermore, in the case of ‘Claimant A’, there were no medications found in his/her profile indicating the presence of any such catastrophic condition, or in fact, of any condition requiring pain management.
  • Thus, the chronic use of a potent narcotic medication like OxyContin® at such extensive doses in the absence of any obvious chronic pain condition can only be described as suspicious.
  • OxyContin® is a commonly abused and diverted drug and the one that’s been receiving the most attention in the media these days.  Based on the rumoured value at least $1 per milligram, the potential street value of this individual’s OxyContin® claims was over $375,000 in this single year alone.

Yes, it happens – and more often than we’d like to report.  We’ve seen cases like that of ‘Claimant A’ in employer-sponsored plans from all across the country.  Whether such large quantities of narcotics are being abused, diverted or both, it is imperative that plan sponsors work with their benefits providers to implement additional plan provisions or therapeutics limits programs help ensure the responsible, safe and appropriate utilization of prescription narcotic drugs.  Not only will such programs facilitate good governance and risk management for sponsors, but they will also help address this substantial and growing social issue.

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