Utilization Patterns of Compounded Medication

Apr 28, 2014
The 2013 Workers’ Compensation Drug Trend Report highlights our multipronged analysis of compounded medications from the drug, state, pharmacy and physician perspective.
  • Workers' Compensation Insurance

As recently highlighted in Business Insurance, compounded medications cost workers’ compensation payers 126% more per user in 2013 than in 2012. The number of injured workers using compounds doubled to 2%.

The increase in compounded medication use comes despite research questioning the effectiveness and safety of compounded medications when used to treat work-related injuries. Our analysis found no clinical evidence that compounded medications commonly used in workers’ compensation are more effective than commercially available, manufactured drugs.

We examined the use of compounded medications in workers’ compensation in greater depth in the 2013 Express Scripts Workers’ Compensation Drug Trend Report and found some interesting trends:

  • Of the nearly 153,000 physicians prescribing medications to injured workers in our analyses, only 2.1% prescribed compounded medications.
  • High-compounding pharmacies – those that dispensed at least two-thirds of their prescriptions for compounded products – had a median price increase of 151% for compounded products from 2012 to 2013.
  • By contrast, low-compounding pharmacies – dispensing fewer than 67% of their prescriptions as compounded products (e.g., traditional retail pharmacies) – had a median price increase of only 71% for compounded products.
  • For approximately 25% of Express Scripts Workers’ Compensation injured workers with a prescription for a compounded topical pain medication in 2013, there was no evidence of concomitant oral analgesic therapy, indicating that other cost-effective, clinically equivalent alternatives had not been tried first. 

State Analysis

In addition, patterns of compounded prescriptions varied based on geographical location. Prevalence – the number of injured workers filling a prescription for at least one compounded product – increased in every state included in the analysis, indicating the need for payers to pay attention to the growing cost impact of compounds. Louisiana had the greatest increase in prevalence (225%).

However, some states saw a decline in the number of compounded prescriptions per injured worker.

  • Texas saw an increase of 120.2%, from 1.88 to 4.14 compounded prescriptions per compound user.
  • California had the largest decrease – 19.2%.

Drug Analysis

The significance of compounds in workers’ compensation was clearly demonstrated in the cost variation for just two common ingredients: diclofenac and gabapentin.

A prescription of diclofenac is often compounded in strengths different than those in commercial preparations. The average cost per prescription for compounded versions of diclofenac was $770 in 2013 compared to $46 per prescription for a commercially available alternative. Gabapentin cost $1,146 more per prescription in compounded formulations.

By examining patterns of compounded medication use from the drug, state, pharmacy and physician perspectives, we are able to gain insights to improve our ability to manage this class of drugs and continue our commitment to the development of proven, empirically based pharmacy solutions.

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