Pain Management and Worker’s Compensation SV RIMS March 23, 2017

Agenda Panel Introduction ‘Simple’ Injury, Complex Problem Risk Management Perspective Marijuana in the Comp System Seeking a ‘remedy’

Panelists Roman Kownacki, MD Eddie Kwan Mark Poyadue Allen Kwan Medical Director of Occupational Health Risk Manager Senior Work Comp Claims Advisor Kaiser Permanente Mi Pueblo Foods Marsh Moderator: Allen Kwan Swiss Re Corporate Solutions

Workers Comp Claimant

Simple Injury, Complex Problem Roman Kownacki, MD Kaiser Permanente

Simple Injury 42 yo Office Worker Exiting the restroom, another person entering forcing her wrist back, hyperextension PMH: Depression (Cymbalta), previous work injury to foot and back Initial evaluation: Normal x-rays Diagnosis: wrist sprain Tx: Ice, Tylenol, support

Follow-Up Week 1:PT ordered, added Tramadol Week 2: Tramadol stopped, Tizanidine added Week 3: Added Tylenol #3 Week 4: Renewed Tylenol #3 Week 8: Renew Tylenol #3, Tizanidine, Add Neurontin, Chronic pain referral

9 Months Later Treatment to date: PT, Acu, OT, Multiple injections, Biofeedback Taking Flexeril, Valium, Lyrica, Effexor, Restoril, Norco, Oxycodone Not working Surgery proposed

Simple Injury PROBLEM

Risk Management Perspective Eddie Kwan

Risk Management Perspective Failure to report claims early Managing pain management in claims Abuse of Opioids Return to work program Alternative treatments

Marijuana in the Comp System Mark Poyadue

Workers’ Compensation and Medical Marijuana MARIJUANA AS MEDICAL TREATMENT Medical research indicates that marijuana has therapeutic potential. Can relieve pain, control nausea, and stimulate appetite. Less expensive, less addictive than narcotics. But FDA has not approved marijuana for medical use. Many states allow insurers to deny workers’ compensation payments for medical marijuana. Court rulings on this topic have varied. Despite state laws, marijuana is a Schedule I drug under the Federal Controlled Substances Act of 1970 (CSA).

State Marijuana Laws (AS OF NOVEMBER 9, 2016 Legal Medical and Recreational Use Comprehensive Legal Medical Use Limited Legal Medical Use Pending Ballot Measures to Legalize Recreational Use District of Columbia Source: National Conference of State Legislatures, news reports

FDA and Medical Marijuana Synthetic Cannabinoid Medications for Oral Administration FDA Approved Cannabinoid-based medications: MARINOL® (dronabinol). Cesamet™ (nabilone) . Indications for Use: Relieving Pain (chronic and neuropathic). Treating nausea and vomiting. Decreasing ocular pressure. Stimulating appetite.

Pharmacy Benefit Management (PBM) Considerations Pharmacy Reimbursement Procedures Not Dispensed at Retail or Home Delivery Pharmacies No Reject Process Coding Schedule 1 Substance Not FDA Approved Drug Utilization & Medical Bill Review No NDC Number or CPT Procedure Code Unlisted Code Pain Management Alternatives Medical Provider

Seeking a ‘Remedy’ Panel Discussion

Managing Pain Solutions Reporting Claims early Claims Frequency vs Severity MPN / Nurse Intake Services Develop Guidelines with your TPA / Carrier Clearly Communicate Company’s Position Request Immediate Discussions when: Claim Submitted for Reimbursement Regulatory Concerns Can I drug test after an accident?

Swiss Re Corporate Solutions Panelist Contact Info Roman Kownacki Eddie Kwan Mark Poyadue Kaiser Permanente Mi Pueblo Foods Marsh Roman.Kownacki@kp.org Eddie.Kwan@mipueblo.com Mark.Poyadue@marsh.com Moderator: Allen Kwan Swiss Re Corporate Solutions Allen_Kwan@swissre.com

THANK YOU !