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2012 Rx Utilization Dropped for Workers Comp Payers While Drug Trend Rose

Posted on: May 14, 2013 by Caitlin Morgan

2012 Rx Utilization Dropped for Workers Comp Payers While Drug Trend Rose

Report: 2012 Rx Utilization Dropped for Workers Comp Payers While Overall Drug Trend Rose

New research cited in Express Scripts’ 2012 Workers’ Compensation Drug Trend Report shows that utilization of prescription drugs for workers’ compensation payers declined last year even though the overall drug trend rose. Published annually since 1997, the Express Scripts Drug Trend Report provides the healthcare industry with a detailed analysis of prescription drug costs and utilization.

Narcotics once again accounted for the highest spend among therapy classes in workers’ compensation with utilization declining 2.7%. At $132.52, OxyContin (oxycodone extended release) had the highest average per-user-per-year cost and accounted for 9.7% of total drug spend in 2012, despite a 6.1% decrease in utilization, according to the Express Scripts report.

Tim Pokorney, pharmacist, and clinical director of workers’ compensation at Express Scripts, noted that the findings demonstrate the need for effective prescription-drug management programs for workers’ compensation payers. “Payers need innovative solutions that help them drive the use of clinically equivalent, cost-effective generics that can help rein in their overall pharmacy spending,” Pokorney said.

Monitoring Drug Use

In the U.S., prescription drug overdoses result in 1.2 million emergency room visits and more than 15,000 deaths each year — more than cocaine and heroin combined. Moreover, narcotics comprise more than a third of the cost and utilization in workers’ compensation, and given the potential for misuse and abuse, payers need a focused approach to managing their use. This includes implementing a fraud program that comprises of data analytics coupled with clinical expertise and investigative services. Providers of such programs look for patterns of behavioral red flags to find cases that may otherwise be missed.

At the Workers’ Compensation Research Institute’s (WCRI) 2013 annual conference, four experts recently discussed methods to address actual and potential abuse of narcotics. One expert, Peter Kreiner, Ph.D., of Brandeis University in Waltham, Mass., discussed effective drug monitoring methods including one in which physicians and pharmacies that dispensed opioids to claimants comprehensively reported that activity to the relevant state agency. The state agency would then distribute the information to physicians, pharmacies, and law enforcement agencies. This would help ensure that a treating physician was fully aware of all the opioids that a specific physician and other medical service providers prescribed a claimant. It would also work towards hindering physician shopping by claimants who saw multiple doctors as an effort to obtain redundant opioid prescriptions. Including law-enforcement agencies in the distribution list helped identify physicians and pharmacies that dispensed an unduly large amount of opioids.

Dr. Kreiner also advocated:

  • Requiring that the person who picked up an opioid prescription provide identification to help ensure that the correct person received that medication
  • Mandatory physician and pharmacy registration in and active use of a state-operated prescription drug-monitoring programs (PDMPs)
  • Tying PDMPs with other relevant monitoring systems

Caitlin-Morgan specializes in helping agencies and brokers with their insureds’ Workers Compensation programs. We can also help with risk management and loss prevention, along with Return to Work Programs, to help stem losses. Give us a call at 877.226.1027 for more information.

Sources:  Express Scripts, WCRI, Workers Compensation Law Community, Business Insurance

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Posted in: Substance Abuse Facilities Workers Comp Workers Compensation