Controlling Utilization Key for Workers’ Comp

Aug 27, 2013
Workers' comp cost per injured worker is increasing. A new report from Express Scripts highlights solutions to help workers' comp payers reduce utilization.
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  • Workers' Compensation Insurance

Narcotics make up more than one-third of workers’ compensation pharmacy expenses and also have a high potential for dependency. Express Scripts helped workers’ compensation payers reduce the use of narcotics and other medications commonly used to treat work-related injuries last year, according to the Express Scripts 2012 Workers’ Compensation Drug Trend Report.

Narcotics a Significant Class

The report shows that narcotic analgesics, the class with the highest spending in workers’ compensation, saw utilization decline 2.7%. OxyContin®, which accounted for nearly 10% of the total drug spend, had a 6.1% drop in utilization, although at $132.50, it still represents the highest average cost per user.

Overall, trend for workers’ compensation payers rose 2.9% in 2012, reversing two years of decline. This was fueled by new products and new product indications, as well as an increase in cost per user. Two therapy classes alone, antidepressants and dermatologicals, saw greater than 10% increases in cost per user. Increased cost per prescription for one medication — Lyrica® — contributed to a higher trend for anticonvulsants.

Programs to Reduce Utilization

Express Scripts offers several programs, such as oral fentanyl intervention and long-acting narcotics outreach to physicians, that help control utilization. Workers’ compensation payers also can benefit from proven products such as step therapy, narcotics education for injured workers and physicians, drug utilization review, physician peer-to-peer and formulary-management programs.

Clinical Research Fuels Innovation

One product that helps manage trend for clients is a communication program that encourages injured workers to use lower-cost generic equivalents. The product is based on the findings of an Express Scripts research pilot that demonstrated how injured workers who received a letter explaining how their prescription drug choices could help control the rising cost of healthcare were 60% more likely to choose a generic equivalent. These and many other insights are available in the full Express Scripts 2012 Workers’ Compensation Drug Trend Report.

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Lab Staff
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