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

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

3. 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

4. Workers Comp Claimant

5. Simple Injury, Complex Problem
Roman Kownacki, MD Kaiser Permanente

6. 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

7. 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

8. 9 Months Later
Treatment to date: PT, Acu, OT, Multiple injections, Biofeedback
Taking Flexeril, Valium, Lyrica, Effexor, Restoril, Norco, Oxycodone
Not working
Surgery proposed

9. Simple Injury PROBLEM

10. Risk Management Perspective
Eddie Kwan

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

12. Marijuana in the Comp System
Mark Poyadue

13. 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).

14. 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

15. 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.

16. 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

17. Seeking a ‘Remedy’
Panel Discussion

18. 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?

19. Swiss Re Corporate Solutions
Panelist Contact Info
Roman Kownacki
Eddie Kwan
Mark Poyadue
Kaiser Permanente
Mi Pueblo Foods
Marsh
Moderator:
Allen Kwan
Swiss Re Corporate Solutions

20. THANK YOU !