transforming risk into opportunity
May 24, 2019
TRISTAR Drug Weaning Program

Opioid misuse is a major issue both socially and economically, and the epidemic continues to dominate the headlines. In response, TRISTAR has designed and implemented processes to limit and control substance abuse. We achieve this by customizing formularies with our Pharmacy Benefit Management partners (PBMs) and by working closely with physicians to improve patient outcomes. In 2018 the managed care team saw a 50% reduction in opioid misuse and a 64% decrease in pharmacy costs, the results demonstrate the success of this program.


While the financial results speak for themselves, it is the patient behind the numbers that matters. Take for an example a female employee who injured her lower back in her late 20’s. She suffered multiple failed back surgeries, unsuccessful physical therapy, and has a history of pain medication and opioid misuse for the last twenty years. How did TRISTAR assist this employee in gaining control over her opioid dependency?


In 2017, a TRISTAR adjuster submitted the claimant’s file to Utilization Review for medical necessity. Shortly thereafter the nurse case manager identified her as a candidate for TRISTAR’s weaning program. The case was transferred to our pharmacy specialists for assessment. TRISTAR’s Peer Review Medical Director and nurse case manager then informed the treating physician that her care was outside of the Medical Treatment Utilization Schedule (MTUS) guidelines, and recommended TRISTAR’s weaning program. Over the next year our case manager and the physician worked closely together to evaluate and treat the patient holistically, implementing alternative solutions for pain management such as acupuncture, while decreasing her pain medication.


Today, we are proud to report that the injured worker is weaned off opioids and is very motivated to continue to improve her health and treatment. We have decreased her total life time incurred medical costs from $1,315,896 to $621,684. This is truly a success story for both the employer and especially for the patient.


At TRISTAR it is our core value to “Do the Right Thing”. Not only do we strive to be fiscally responsible for our clients, but we also work to improve the medical outcomes for our claimants/injured workers.


This is just another example of how TRISTAR is transforming risk into opportunity.


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