A Healthesystems publication

Winter 2016

Pharmacy Management – Don’t Overlook the Impact of Age and Comorbidity


The presence of comorbid conditions within a workers’ compensation claim can impact pharmacy management in ways that go beyond the obvious. Superior pharmacy management requires looking not only at drug therapies, but also considering the various characteristics of the patient who is receiving them.

Claims with a comorbidity have been steadily increasing over the last decade, contributing to increases in overall medical costs.1 In general, comorbidities add to the complexity of a claim as more drug therapies are added to manage multiple conditions, in addition to the medications treating the work-sustained injury or illness. This leads to polypharmacy and a greater potential for drug-drug or drug-disease interactions. It can also mean the presence of multiple prescribers to manage different conditions, making it impossible for any one physician to manage a patient’s complete treatment plan.

But certain comorbidities bring some unique considerations to pharmacy management in the injured worker. The following are some examples of note:


Examples of respiratory comorbidities include chronic obstructive pulmonary disease (COPD), asthma, sleep apnea, and other breathing disorders.


Psychosocial disorders such as depression and anxiety are prevalent within the injured worker population. These disorders can predispose an injured worker to chronic pain, impede recovery and return to work, and increase the potential for opioid misuse3; thus it is important to address and treat psychosocial comorbidities. But psychotropic drugs used to treat these disorders can introduce their own risks.


The aging workforce continues to have an increasing impact on the management of workers’ compensation claims populations. While age itself isn’t necessarily a comorbidity, claimants with a comorbid condition are often older than other claimants and require some specific prescribing considerations.1


Hypertension (high blood pressure) is the most prevalent comorbidity among claims examined by the National Council on Compensation Insurance (NCCI).1


A history of substance abuse, including prescription medications, illicit drugs, or alcohol, is the number one red flag for potential opioid abuse. However, there are other considerations beyond opioids when determining appropriate pain management strategies for these patients.

Silvia Sacalis, PharmD, provides clinical leadership as Vice President of Clinical Services at Healthesystems. Her experience and clinical expertise span the PBM, retail pharmacy and managed care environments. Leveraging her technology background, clinical skills and management expertise, she helps develop and operationalize strategic clinical initiatives to help workers’ compensation insurance payers maximize the impact of a pharmacy benefit management program. Throughout her career, she has held various leadership roles in which she provided oversight of the development of clinical services programs, and integration of analytics technology with clinical consultative support.



1 -Laws C, Colon D. NCCI Research Brief: Comorbidities in Workers Compensation. October 2012
2 -Dowell D, Haegerich TM. CDC Guidelines for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR Recomm Rep. 2016;65:1-49. DOI:http://dx.doi.org/10.15585/mmwr.rr6501e1
3 -Arteta J, Cobos B, Hu Y, et al. Evaluation of how depression and anxiety mediate the relationship between pain catastrophizing and prescription opioid misuse in a chronic pain population. Pain Med. 2015 Aug 3. [Epublished ahead of print]
4 -Centers for Disease Control and Prevention. Vital Signs: Prescription Painkiller Overdoses. July 2013. http://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html
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