Cost Increases Drive Higher Drug Trend for Workers' Compensation

Apr 10, 2014

Overall drug trend for workers’ compensation increased 9.5%, according to the Express Scripts Workers’ Compensation Drug Trend Report.

  • Workers' Compensation Insurance
  • Pain
  • Inflammatory Conditions
  • Anticoagulants

Overall drug trend for workers' compensation increased 9.5%, according to the Express Scripts Workers' Compensation Drug Trend Report, primarily from an 8.2% jump in cost per prescription.

Workers Comp Components and Drivers of Trend for the Top 10 Workers Compensation Therapy Classes

The Increasing Challenge of Compounded Medications

Compounded medications led the way, with per-user-per-year costs soaring 126% higher. Although these medications account for just 2.7% of pharmacy costs in workers’ compensation, the dramatic rise in price significantly impacted overall trend.

Compounded medications are tailored drugs prepared by mixing, combining or altering ingredients. While intended to address special pharmaceutical needs of some injured workers, compounds tend to be significantly more expensive than commercial formulations and in many cases, there are FDA-approved alternatives for compounded medications.

Without consistent protocols to prepare each drug, compounded drugs can have a greater batch-to-batch variability – meaning injured workers could be receiving medication with a higher potency than intended. 

Express Scripts Helps Payers Manage Rising Costs

At the point of sale, clients have the option of reviewing all compounds for authorization. Retrospectively, Express Scripts sends letters to physicians encouraging the use of commercially available, cost effective alternatives where appropriate. Our research has shown that 42.3% of injured workers whose physicians received such communications from Express Scripts discontinued filling compounded medications, thus helping drive down costs for payers.

Other Key Findings from the 2013 Workers’ Compensation Drug Trend Report

Narcotics analgesics continue to be the most expensive therapy class for work-related injuries – 32% of overall pharmacy costs. However, utilization for narcotics has declined for the third straight year.

Non-Steroidal Anti-Inflammatory Drugs – or NSAIDs – which are non-narcotic medications used to address various pain conditions, saw a 19.4% increase in cost and was the second highest trend driver. 

Specialty medications, including those to prevent blood clots following a surgery, osteoarthritis and inflammatory conditions, make up only 1% of overall pharmacy spend in workers’ compensation but pose a growing cost challenge for payers. The average cost per prescription of a specialty medication was more than $1,119 in 2013 – nearly nine times that of traditional medication.

These and many other insights are available in the full Express Scripts 2013 Workers’ Compensation Drug Trend Report.

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