Workers' Compensation Rx Drug Spending Increased 2.2% in 2015

Apr 5, 2016

Opioids remain the costliest therapy class, yet Express Scripts management programs drove down utilization for fifth consecutive year.

  • Workers' Compensation Insurance


Rising drug prices contributed to a 2.2% growth in pharmacy spending for American workers’ compensation payers in 2015, according to the 2015 Workers’ Compensation Drug Trend Report.

Effective management programs helped lower injured workers’ drug utilization by 2.6% last year, offsetting the 4.4% increase in the average cost per prescription.

In its tenth annual edition, the Express Scripts Workers’ Compensation Drug Trend Report evaluates year-over-year changes in medication costs and utilization for injured workers. Opioid and compound drug management continues to be a focus for this market segment, and the rising cost of specialty medications is emerging as a key budgetary challenge for workers’ compensation payers.

Components of Trend for Workers Compensation

Opioid Management Programs Hold Down Spending

At $450.90 per-user-per-year (PUPY), opioids continue to be the costliest class of medications for occupational injuries. Yet, overall spending for opioids decreased nearly 5% as utilization decreased by almost 11%. On average, injured workers received 2.91 opioid prescriptions per year – down from 3.33 prescriptions in 2014.

When prescribing habits pose risk to patient safety, we create solutions to mitigate any potential harmful effects. Over the past 30 years, our researchers, clinicians and product innovators have worked together to leverage the insights from an industry-leading set of data to create novel programs that address the biggest concerns of workers compensation payers.

As opioid utilization continued to rise in prior years, Express Scripts introduced a proactive and retrospective look at opioid prescribing with tools such as the Morphine Equivalent Dose (MED) point of sale and prescriber outreach solutions, and injured worker narcotic education outreach. These programs provide a comprehensive look at the injured workers’ opioid use and identify escalation in the dose that might be of concern.

One Express Scripts client that implemented the MED Management program had a 46.1% decrease in patients receiving opioids and a 51.5% drop in prescriptions with MED higher than 120 mg/day within one year.

Express Scripts continues to build new, proactive tools that help our clients ensure that opioids are used as safely as possible. Our predictive analytics identify risk behaviors from the first prescription fill and then throughout treatment so risk managers can engage with injured workers to improve treatment outcomes.

Impact of Specialty Medications Realized in 2015

While specialty medications represent less than 1% of all medications used by injured workers, rapidly rising prices are a major concern. Spending on specialty medications increased 49.5% in 2015, with the average cost per prescription reaching $1,799.02 – nearly 10 times that of a typical traditional medication.

Antiviral medications to treat hepatitis C and HIV were primary drivers of the annual increase in overall specialty drug spending. Spending in the antiviral class increased 85.1%, heavily influenced by a 66.7% increase in cost per prescription.

Combatting Rising Compounded Medication Costs

For the third consecutive year, compounded products were among the top 10 therapy classes as ranked by total spending in 2015.

The cost to payers for compounded medications averaged $1769.45 per prescription in 2015. However, better education and management programs have led to a significant decrease in utilization.

Because compounded medications are not reviewed by the FDA for safety or efficacy, these products may pose unnecessary risks for injured workers and therefore are not considered first-line therapies within workers’ compensation treatment guidelines. Express Scripts proactively addresses compound use through physician and patient education and our prior authorization capabilities.

Last year, Express Scripts compound management solutions helped lower spending on these products by 33.7%. It is clear that by managing compounded medications, clients can reduce unnecessary costs and waste associated with more than 1,000 clinically unproven ingredients.

Compounds Trend

Author Bio

Lab Staff
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