U.S. Workers’ Comp Rx Spending Decreased 3.3% in 2017

Apr 10, 2018
Opioid utilization declined for seventh consecutive year driven by aggressive clinical solutions and increased regulatory activity.

WC DTR 2017

Workers’ compensation pharmacy spending decreased 3.3% in 2017, according to the 12th annual myMatrixx Drug Trend Report.

By merging the core capabilities of Express Scripts and myMatrixx to deliver superior clinical expertise, market-leading client experiences and innovative technology-based solutions, we are now uniquely positioned to serve workers' compensation clients and injured workers. We’re doing more to help clients balance appropriate care for injured workers while keeping costs down.

More than half of myMatrixx Workers’ Compensation plans reduced drug spending last year.

Curtailing the Opioid Epidemic

Spending on opioids declined 11.9% for workers’ compensation payers in 2017.

For decades, myMatrixx has championed safe and appropriate use of opioids through solutions that leverage data, educate those at risk for adverse events and ensure connectivity across the care continuum. In addition, many states have taken action to address the opioid crisis through a multifaceted approach involving state-specific formularies, opioid guidelines and limits on initial opioid dispensing days’ supply and/or morphine equivalent dose.

These factors resulted in 74.2% of workers’ compensation payers spending less on opioids in 2017 than in 2016.

While a decrease in the utilization of opioids is a positive sign for the workers’ compensation industry, there is still work to be done.

Our research found dangerous drug combinations and long-term use of opioids still pose care and cost concerns. Nearly 40% of injured workers took an opioid along with a muscle relaxant, while 9% took an opioid and benzodiazepine. Taking these medications together can increase the risk of side effects and death from respiratory depression.

By deploying a holistic approach to manage opioid use, myMatrixx works with physicians, pharmacists and injured workers to mitigate the concerns of drug interactions or overuse.

Additionally, myMatrixx noted by the eleventh year of injury, the cost per injured worker reached $3,402.07, with $1,862.36 spent on opioid medications. Among those with age of injury of 10 years or more, more than half filled an opioid medication in 2017.

Compounded Medications Decline Further

For the third year in a row, spending on compounded medications decreased – a decline of 37.9% in 2017, falling out of the top 10 therapy classes.

While compounded medications continue to be a focus because of their high cost, it is clear that effective management strategies can reduce unnecessary costs and waste associated with clinically unproven ingredients.

Specialty Medication Utilization Remains Low, but Growing

Spending on specialty medications to treat conditions such as HIV and osteoarthritis increased 3.8% in 2017. While these drugs represent less than 1% of all medications used by injured workers, the extreme high cost per prescription requires payers to stay vigilant.

Payers who have injured workers with occupational exposure to needle-sticks often include HIV medications on their formulary to ensure quick access to work-related HIV prophylaxis therapy. This therapy class saw the highest spending among specialty medications.

Other Key Findings of the Workers’ Compensation Drug Trend Report include:

  • Generic fill rate increased to 85.6% across our workers’ compensation payers in 2017. Yet, payers could have saved $80.8 million through an optimal mix of clinically appropriate generic options.
  • The average cost of a physician-dispensed medication was $270.70, compared to $108.49 for a pharmacy-dispensed medication. This means plans paid a $162 premium for physician-dispensed medications which bypass pharmacist review at the point of sale. Of the medications dispensed by physicians, nearly half are used to treat pain.
  • On average, payers spent $1421.36 per injured worker for prescription medications in 2017.

Click to download the report.

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