Better Decisions in Workers’ Compensation

Oct 15, 2013
Express Scripts Workers' Compensation team is uniquely positioned to address safety and financial concerns through research-driven solutions.
  • Workers' Compensation Insurance

While Americans represent only 4.5% of the world’s total population, we consume 85% of the world’s narcotics. In fact, narcotics make up one-third of the cost and utilization of all medications in workers’ compensation. While these drugs can be an important part of the treatment for work-related injuries, the impact of the widespread use of narcotics is a major area of concern for payers.

Payers also face myriad other issues, including third-party billing, compounded drugs, physician-dispensed medications and the need for regulatory expertise.

Activating Healthier Decisions

Express Scripts research shows that pharmacy-related waste is costing the country billions of dollars — more than $2 billion in workers’ compensation alone. In order to drive waste from the workers’ compensation system, better decisions are required from injured workers, physicians and payers.

Express Scripts applies insights from our behavioral science research to develop clinical trials and pilots that are tested in real-world situations and implement industry-leading solutions for payers.

Understanding Injured Worker Behavior

Our research has demonstrated that injured workers want to do the right thing, regardless of financial incentives. Activating this intent through message framing has a strong impact on decisions made about medications.

We leveraged this insight in a pilot designed to encourage conversion to low-cost, clinically equivalent generic medications. Study results showed that injured workers who received a letter about how their choice of medications could help save money for their employer and the nation were 60% more likely to choose a generic equivalent. We also have letter programs in place for home delivery and physician-dispensed medications.

Actionable Data for Safety and Savings

As the most costly therapy class for work-related injuries, prolonged narcotic use not only adds financial burden but has been shown to be associated with poorer outcomes and longer disability. Although our aggressive management programs helped bring down narcotic utilization by 2.7% last year, effective monitoring to ensure appropriateness of use and identifying potential abuse and misuse continues to be a challenge.

Broader Insight Brings Strategic Solutions

Express Scripts is uniquely positioned to leverage research, data and clinical insights to promote better outcomes. Our solutions focus on three key decision areas to safeguard injured workers and provide cost savings for payers:

Drug Mix:

  • Providing consultative outreach for physicians to choose safe and cost-effective medication from a customizable formulary
  • Encouraging the use of lower-cost, clinically equivalent generic options

Channel Management:

  • Providing convenience and cost savings through our pharmacy network and home delivery options
  • Giving greater oversight to address the challenge of physician-dispensed medication
  • Streamlining administrative burden through paper bill conversion


  • Addressing potential adverse effects, gaps in care or overprescribing
  • Analyzing drug utilization in real time and retroactively
  • Detecting and educating injured workers about the effects of narcotic dependence and addiction

By combining our research efforts with our clinical capabilities and expertise, unique solutions increase savings for payers and safety for injured workers by driving out pharmacy-related waste and reducing narcotics misuse and abuse.

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