Workers’ Comp Rx Spending Decreased 7.6% in 2016

Apr 4, 2017
Express Scripts lowered prescription drug spending for workers' compensation payers by 7.6% in 2016, according to the 11th edition of our Workers' Compensation Drug Trend Report.
  • Workers' Compensation Insurance
  • Compound Medications
  • Pain


In a year when many payers wrestled with drug price increases that dominated the news, Express Scripts protected clients from this impact. By practicing pharmacy smarter, we helped clients balance appropriate care for injured workers while keeping costs down.

Decrease in Opioid Use Drives Down Trend

In 2016, opioids remained the most expensive therapy class at $391.35 per user per year (PUPY). Thirteen of the top 25 workers’ compensation medications were opioids.

However, for the sixth year, overall opioid trend decreased. In 2016, trend decreased 13.4% due to a combination of Express Scripts’ clinical solutions, aggressive client management, and state and federal opioid regulatory trends. This stark decrease in overall pharmacy trend – heavily driven by decreased opioid utilization – proves key stakeholders are taking action to combat the epidemic of opioid abuse and misuse:

  • Payers: Through point-of-sale programs, physician outreach, patient education and advanced analytics, Express Scripts’ solutions enable payers to combat the safety and cost concerns associated with opioid use from every angle.
  • Prescribers: Scrutiny of opioid prescribing patterns drove the creation of new guidelines from the Centers for Disease Control and Prevention (CDC), as well as the Surgeon General’s Report on Facing Addiction in America.
  • Regulatory: Many states have adopted or are considering formularies, opioid prescribing limits or other medical treatment guidelines.

Bending the Curve on Compound Spending

For the third year in a row, spending on compounded medications decreased. In 2016, trend was -28.6%.

These drugs still remain very costly, yet with a 31% decrease in utilization, it is clear that effective management strategies can reduce unnecessary costs and waste associated with more than 1,000 clinically unproven ingredients.

Optimizing the Dispensing Channel

Medication dispensed directly to injured workers by prescribers may result in additional costs as the drugs are typically repackaged or relabeled and often are not subject to the same pricing regulations as those dispensed by a pharmacy. Injured worker safety is also a concern.

Physician-dispensed medications lack the point-of-sale safety edits which occur at a retail or home delivery pharmacy. This puts injured workers at risk for potential drug interactions or duplication of therapy.

According to 2016 data, the average cost of a physician-dispensed medication was $219.25, compared to $110.16 for a pharmacy-dispensed medication. Express Scripts Workers’ Compensation clients therefore paid an average premium of about $109 for physician-dispensed medications and bypassed pharmacist review at the point of sale.

When prescriptions are filled through more costly channels, such as an out-of-network pharmacy or third-party biller, payers incur additional cost, with no additional value. This results in waste in the healthcare system.

For long-term medication needs, drugs delivered directly to an injured worker’s home cost payers 15% less than those purchased from a retail pharmacy, while adding convenience for the injured worker.

Continued Vigilance for Specialty Medication Trends

Spending on specialty medications to treat conditions such as hepatitis C and HIV stabilized in 2016. 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.

Managing specialty spend requires clinical expertise and strategic guidance. Clinicians at Express Scripts and our specialty pharmacy Accredo® have disease-specific experience to ensure safety, promote adherence and provide individualized clinical counseling for injured workers with the most complex conditions.

Read the full report here

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