Getting a second chance at life

the obstacle

In 1995, Donna sustained multiple back injuries while working as a flight attendant. Over the years, her treatments have increased in frequency and in cost. She had also moved out of the state where her injury occurred, and it was uncertain whether her new prescriber was familiar with the injury-state’s guidelines on opioid management. 

the opportunity

Donna’s nine-medication pharmacy regimen included a costly opioid that is typically reserved for pain management for advanced illnesses, such as terminal cancer—yet she was still living pill to pill and in consistent pain. Her claim was referred to ANS for the development of a Medicare Set-Aside (MSA). We started with our risk-free triage to identify the high-dollar exposure, then recommended our pharmacy intervention program to follow. Our nurse experts worked with Donna’s prescriber to decide on alternate treatment options that would improve her quality of life while complying with jurisdiction-based best practices.

the outcomes

A well-received face-to-face conversation between our nurse expert and the treating provider resulted a secured agreement from the provider to wean Donna from the costly opioids which also placed her at risk for serious adverse side effects. Over time the weaning program enabled Donna to consolidate her treatments, making them far more manageable. Through successful collaboration, we dramatically reduced the use of opioids—which dramatically reduced the opioid pharmacy spend from $88,000 per year to $47,600 per year. By starting with the risk-free assessment, we were ultimately able to mitigate the pharmaceutical cost before paying for a high MSA.