August 2010

A 49 year old male suffered multiple lower back injuries while he was involved in an accident at work. Since then, the patient has been diagnosed with chronic nociceptive and neuropathic pain, major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The patient has been treated by a psychiatrist and a pain specialist in an attempt to alleviate his symptoms associated with his injury. 

 

A clinical pharmacist completed a comprehensive review of the claimant’s prescription history and medical records, which revealed multiple concerns regarding the patient’s pain management and psychiatric care. This patient was taking 15 medications prescribed by two different physicians.  Because several medications were identified as unnecessary and potentially harmful to the patient, the pharmacist suggested they be tapered and discontinued.  The pharmacist also proposed certain medications be switched to those which were more ideal for conditions being treated and recommended the reintroduction and dose titration of a medication indicated to treat neuropathic pain. In doing so, fewer opioid analgesics would be necessary for controlling his overall chronic pain. Finally, a dosage modification and conversion to a more cost effective generic alternative was also suggested.

 

After corresponding with the two treating physicians, some of the aforementioned recommendations were agreed upon and will be implemented. The psychiatrist agreed to gradually taper the patient off of two unnecessary, unsafe medications, as well as modify the dosage and prescribe a generic alternative for an antidepressant. The pain specialist agreed to reinitiate medication therapy to better treat the claimant’s neuropathic pain.  

 

Current annual prescription costs: $46,730

Projected annual prescription costs (with all recommendations accepted): $24,228

Projected potential savings (with all recommendations accepted): $22,502