Tag: 2018 News

Doctors who are cutting back on prescribing opioids increasingly are opting for gabapentin, believed to be a safer, non-narcotic drug. The anticonvulsant is available in generic form and sold under the brand names Neurotonin and Gralise, among others. However, recreational use and abuse of the prescription drug is on the rise, and the increase has raised concern among officials in several states.

The Food and Drug Administration has approved gabapentinoids for the treatment of postherpetic neuralgia (gabapentin and pregabalin), fibromyalgia (pregabalin), and neuropathic pain associated with diabetes or spinal cord injuries (pregabalin).

Past marketing practices also help explain the growing use of gabapentinoids for various types of pain. The manufacturer (Parke-Davis, a subsidiary of Warner-Lambert, which was later acquired by Pfizer) engaged in an extensive marketing campaign to increase off-label prescribing of Neurontin for pain.

On the street gabapentin pills, known as “johnnys” or “gabbies,” which often sell for less than a dollar each, enhance the euphoric effects of heroin and when taken alone in high doses can produce a marijuana-like high.

Gabapentin is currently not a controlled substance in the United States, so federal authorities do not consider it a drug with a high potential for abuse. But recent data indicate that the drug promoted as an alternative to opioids is one to watch as gabapentin-related complications and overdose deaths are increasing.

Gabapentin is now one of the most popular prescription drugs in the United States, according to the New England Journal of Medicine. It was the 10th-most-prescribed medication in 2016. Its more expensive cousin, pregabalin, sold as Lyrica and also made by Pfizer, was the eighth best-selling.

Some states have taken note of the increase in use and are pursuing stricter measures for access to the drug.

Gabapentin was the No. 1 drug dispensed in Ohio in December 2016, according to the Ohio Board of Pharmacy. In that same year, the medication was dispensed at a greater rate than any other controlled substance. This information promoted the Ohio Substance Abuse Monitoring Network to issue an alert about the illicit use of gabapentin across the state.

Kentucky designated gabapentin as a Schedule 5 controlled substance in July 2017. The regulation requires authorized practitioners to be properly licensed and registered with the DEA before they can dispense the medication.

West Virginia is also tracking gabapentin abuse and may introduce legislation in January 2018 that would aim to classify it as a controlled substance in the state. Gabapentin has market value on the streets and it is being abused according to the definition of a scheduled drug, Dr. Brad Henry, president of the West Virginia State Medical Association, told the newspaper.

According to the Charleston Gazette-Mail, “In a recent month, West Virginia pharmacies filled prescriptions for 5.8 million gabapentin tablets – more than the combined number of doses of two popular painkillers, hydrocodone, and oxycodone.”

Ohio also has been monitoring gabapentin prescriptions for more than a year.

People who have abused gabapentin and now find themselves addicted to the drug are advised to avoid going cold turkey. Instead, a professional addiction recovery treatment program is well advised..

Orange County prosecutors charged three defendants with defrauding a workers’ compensation insurance company by misrepresenting uninsured injured workers as employees of a different company.

They are also charged with failing to report wages, withhold payroll taxes, and pay employment taxes for wages earned to California Employment Development Department (EDD).

The three defendants are Veronica G. Lake, 47, of Mission Viejo, Luis Enrique Perez, 49, of Yorba Linda and Scott Wesley Smith, 36, who lives in Orange.

In 2013, Luis Perez owned and operated several temporary employee staffing companies including BaronHR, LLC.

Lake worked for Perez as his Controller, while Smith worked as the Director of Safety.

In September 2013, Smith formed Titan Personnel, Inc. and acted as its CEO, CFO, Secretary and sole Director.

Despite losing its workers’ compensation insurance on July 1, 2013, Perez is accused of unlawfully continuing to operate BaronHR and contract with outside companies to provide temporary employees.

Between December 2013 and September 2014, the defendants are accused of conspiring to fraudulently report 47 injured employees of BaronHR as employees of Titan to American International Group, Inc. (AIG) to avoid liability for its employees who were injured at work, and to hide BaronHR’s failure to obtain workers’ compensation insurance as mandated by law.

As a result, AIG became liable for approximately $393,000 worth of expenses for claims of individuals not covered by their insurance policy.

The defendants are further accused of conspiring to commit tax fraud by failing to report, withhold, and pay employment and personal income tax for 36 BaronHR employees, including individuals they attempted to report to AIG as Titan Personnel employees, to the EDD.

Two years ago the Court of Appeal opened the Pandora’s box of potential litigation against utilization review physicians in a published decision. The California Supreme Court agreed to review the case, and just reversed the Court of Appeal in Kirk King v Comppartners, Inc..

Kirk King suffered anxiety and depression due to chronic back pain resulting from the back injury at work in 2008. In 2011, he was prescribed an anti-anxiety medication known as Klonopin to be provided through Workers’ Compensation. The request for this medication was sent to Utilization Review.

Naresh Sharma, M.D, an anesthesiologist who conducted the utilization review determined the drug was unnecessary and decertified it. As a result, Kirk was required to immediately cease taking the Klonopin. Typically, a person withdraws from Klonopin gradually by slowly reducing the dosage. Due to the sudden cessation of Klonopin, King suffered four seizures, resulting in additional physical injuries.

In September 2013 another request for Klonopin was made by the PTP. Ali, a psychiatrist, conducted a second utilization review and also determined Klonopin was medically unnecessary. Neither Sharma nor Ali examined Kirk in-person, and neither warned Kirk of the dangers of an abrupt withdrawal from Klonopin. Sharma and Ali were employees of CompPartners a Workers’ Compensation utilization review company.

King then sued CompPartners, Inc. and Sharma for (1) professional negligence; (2) negligence; (3) intentional infliction of emotional distress; and (4) negligent infliction of emotional distress. Kirk’s wife, Sara King, sued for loss of consortium. The trial court sustained defendants’ demurrer without leave to amend. The Court of Appeal sustained the demurrer but reversed the denial of leave to amend.

The Court of Appeal decision concluded that the trial court “should have granted the Kings leave to amend because it is possible… that, when more details are provided they could support a conclusion that, under the circumstances, the scope of Sharma’s duty included some form of warning Kirk of or protecting Kirk from the risk of seizures.”

However, the California Supreme Court viewed the case differently. It concluded that the workers’ compensation law provides the exclusive remedy for the employee’s injuries and thus preempts the employee’s tort claims.

The Supreme Court said it is by now well established that the exclusivity provisions preempt not only those causes of action premised on a compensable workplace injury, but also those causes of action premised on injuries collateral to or derivative of’ such an injury. Such collateral or derivative injuries include injuries stemming from conduct occurring in the workers’ compensation claims process.

In performing their statutory functions, utilization reviewers, much like independent claims administrators, effectively stand in the shoes of employers. Thus, the Court concluded that “the exclusive remedy for the Kings’ injuries lies within the workers’ compensation system.”

The battle over high prescription drug prices, unsurprisingly, involves ample amounts of finger-pointing.

Drug manufacturers point to pharmacy benefit managers (PBMs), the powerful middlemen who administer drug coverage for insurers.

The drugmakers argue that the industry practice of providing rebates to large PBMs forces them to raise list prices, and provides PBMs with a perverse incentive to favor pricier drugs in their formularies.

They also charge that the PBMs pocket too much of the rebates to pad their profits, leaving consumers to pay higher prices.

Drugmakers say they are under pressure to provide rebates to the few PBMs that dominate the market, which include CVS, Express Scripts and UnitedHealth’s Optum, and that those payers do not pass on enough of those savings to patients – a contention the PBMs dispute.

The drugmakers say the rebates force them to raise the price of their therapies over time to preserve their business.

PBMs counter that the drug makers are responsible for their high prices, and that there’s no correlation between rebates and rising prices. They say their purpose is to drive down prices for their clients, and they can point to research that shows that most of the money spent on pharmaceuticals in the U.S. goes to the drug makers.

The Trump administration has targeted PBMs and rebates as a key part of its blueprint to lower drug costs. “We’re very much eliminating the middlemen,” President Trump said in announcing the blueprint back in May.

And the Department of Health and Human Services last month proposed regulations to crack down on rebates.

While the PBM industry has challenged that regulatory move, arguing that eliminating rebates would have to be done via congressional legislation, in an interview with Reuters on Friday, Health and Human Services Secretary Alex Azar, a former executive at drugmaker Eli Lilly, said that eliminating rebates was within his agency’s power.

“The question of rebates may very well be fundamental to the issue of how you reverse these constant incentives to higher list prices (for medicines),” Azar told Reuters. But, Yasmeen Abutaleb writes, “He did not say when such new regulations, which are being reviewed by the Office of Management and Budget, might take effect.”

WCAB panel decisions are more frequently approving total disability awards based upon vocational rehabilitation experts. The trend seems to be an erosion of reliance upon the AMA Guides as was the intent of SB 899 when it passed in 2004.

In this new illustrative panel decision, Craig Hanus sustained injuries to his left shoulder, neck, low back and neurological system on November 15, 2014 while employed as a heavy equipment mechanic by URS / AECOM Corporation

Subsequently, in 2015, Hanus obtained a job at Northrup Grumman as a painter. He only lasted six hours before his “body shut down” as it had done when he tried to return to work for his prior employer.

Hanus testified at trial that when he stopped working for Northrup Grumman, he had pain in his hands, arms, shoulders, back, legs, headaches, and “shooting pain in his ears” that would sometimes go to his eyes and affect his eyesight. He currently has pain “everywhere,” has balance problems, and uses a cane to prevent falling. Following left shoulder surgery, he cannot raise his left arm above shoulder level (the court observed his left hand shaking when he lifted it that far) and cannot grip or grasp things in his left hand.

Applicant was seen by a vocational evaluator, Roderick Stoneburner, in October 2017. Mr. Stoneburner’s evaluation and found that he was untrainable and I 00% disabled

After trial WCJ found that Hanus sustained 100% permanent disability, without apportionment, as a result of his admitted November 15, 2014 industrial injury to his left shoulder, neck, low back and neurological system while employed as a heavy equipment mechanic by URS/ AECOM Corporation. The petition for reconsideration by the employer was denied in the panel decision of Hanus v URS/AECOM Corporation.

Defendant contested the WCJ’s finding that applicant is permanently totally disabled, an contended that applicant cannot rebut the 2013 permanent disability rating schedule using methods approved for rebutting the 2005 rating schedule. Defendant further argues that the vocational evidence does not rebut the rating schedule, since the vocational expert used impermissible factors, failed to consider the apportionment determination of the orthopedic Qualified Medical Evaluator and made unsubstantiated assertions that applicant was incapable of sedentary work.

In response the WCAB concluded that “To the extent the WCJ’s finding that applicant is permanently totally disabled is based upon applicant’s work restrictions, as the WCJ discusses in the last paragraph of page 5 of his Report, we note that the rating of permanent disability is not determined by measuring work restrictions, but rather, by reference to the rating of the whole person impairment under the appropriate sections of the AMA Guides.”

“Here, we find the descriptions of the extent of applicant’s impairments which are caused by his industrial injury in the medical reports of Dr. Doty, Dr. Patrick and Dr. Germanovich, as referenced and considered by the vocational expert, Mr. Stoneburner, support the WCJ’s finding that·applicant is permanently totally disabled.”