In middle of pills' paper chain
Business of pain: Tampa's myMatrixx finds that more than 90 percent of its prescriptions are for treating pain and finds its niche.
By KRIS HUNDLEY
Published May 10, 2006
TAMPA - In the world of pharmacy benefits managers, there are the giants like Caremark Rx, Medco Health Solutions and Express Scripts Inc., boasting revenues in the multibillions of dollars. And then there is Tampa's myMatrixx, which hopes to reach $20-million in sales this year.
But myMatrixx, which experienced a 70 percent increase in revenues last year, is gaining a foothold in the prescription processing business because it has found a niche not addressed by the industry's leviathans: trying to get a handle on soaring pain medication costs for workers' compensation and auto insurers.
"We specialize in pain,'' said Steven MacDonald, myMatrixx's chief executive, who founded the company five years ago with pharmacist Guerry Fritch. "Our payers have employees who have been injured on the job or in car accidents. But these customers often don't recognize the overarching disease of pain as the condition they're really paying for.''
The high cost of pain became clear after myMatrixx, originally called Matrix Healthcare Services, spent its first few years in business automating hundreds of thousands of drug claims for customers and creating a paperless processing system. Once the data were collected, the company found that more than 90 percent of all prescriptions were being used to treat pain. Patients with chronic pain - those whose injuries were more than a year old - accounted for 75 percent of the insurers' total pharmacy dollars.
MacDonald, who has a degree in accounting and previously co-founded TechHealth, a specialty managed-care company in Tampa, said prescribing histories showed that doctors, often untrained in pain management, simply added more drugs if the first ones were ineffective.
"If you've got a cholesterol condition and the medicine doesn't work, the doctor will change the drug; it's an iterative process,'' MacDonald said. "In pain management, it's an additive process and that's counterproductive to the best outcome for the patient.''
Though insurers often try to control the treatment costs of conditions like diabetes and congestive heart failure with disease management practices, myMatrixx's effort to apply these techniques to pain is relatively rare, said Dr. Susan Novak, a clinical assistant professor at the College of Pharmacy at the University of Texas in Austin.
Novak, who recently became a paid consultant for myMatrixx, said about 20 percent of people who suffer work-related injuries end up with expensive chronic conditions. And there is growing evidence that poor treatment management in the early stages of the injury contributes to chronic pain.
"Matrixx's approach is to identify people who are going to be chronic early on, then instruct and educate the clinicians,'' Novak said. "The $20-million question will be, once they're identified, what do you do different to prevent chronic pain? This is an evolving science, but it's really exciting.''
Novak said it is too early to see success stories in pain management, which traditionally has consisted of little more than prescribing more pills. But MacDonald, whose 150 customers include workers' compensation programs for the states of Wisconsin and Maine, as well as auto insurers including Geico and Progressive, said there have already been measurable improvements in some patients' lives.
"One lady was on $12,000 a month in migraine medicines,'' he said. "We were able to reduce that to $3,000 a month by weaning her off some pills, reducing her dependency on medications and allowing her to regain some level of functionality.''
MacDonald said his company, which has about 30 employees, works with advisers like Novak as well as the University of Utah's College of Pharmacy to be able to provide doctors with the latest research on effective pain management.
"It's not just a PBM coming at the doctor, it's a research center that supports our opinion,'' MacDonald said of myMatrixx's approach. "We're really interested in getting the patient back to work, which is to everybody's economic benefit.''
MacDonald acknowledged that there may be malingerers who have no interest in returning to the work force. MyMatrixx's prescription database makes it easier to track fraud and abuse, he said.
"But there are lots of people who do want to get better and are seeking responsible, effective pain treatment," he said. "And if they're not treated properly now, they get stuck in that cycle, dependent on medication therapy.''
Kris Hundley can be reached at hundley@sptimes.com or 727 892-2996.