US Workers Compensation Prescription Drug Spending On the Rise


Prescription drug spending increased 2.2% in 2015 for US workers’ compensation payers.

According to the Express Scripts Workers’ Compensation Drug Trend Report, opioid and compound drug management and the increasing cost of specialty medications contributed to a spending increase of 2.2% for workers’ compensation payers in 2015.

For occupational injuries, opioids are the most expensive class of medications, costing approximately $4500 per-person per-year. However, opioid spending decreased by 5% over the last year due to an 11% decrease in opioid usage.

In 2015, injured workers received an average of 2.91 opioid prescriptions per person, which dropped from 3.33 in 2014.

"When prescribing habits pose risk to patient safety, we create solutions to mitigate any potential harmful effects," said Brigette Nelson, MS, PharmD, BCNP, senior vice president of workers' compensation clinical management at Express Scripts. "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 worker’s compensation payers."

To address opioid utilization, Express Scripts introduced prescribing tools such as Morphine Equivalent Dose (MED) point of sale and prescriber outreach solutions and narcotic education outreach for injured workers.

These programs look at injured worker opioid use to identify anything that may be a cause for concern.

"Express Scripts continues to build new, proactive tools that help our clients ensure that opioids are used as safely as possible," said Rochelle Henderson, PhD, senior director of research. "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."

Though injured workers very seldom use specialty medications, Express Scripts still believe that their rising costs are a major concern. Spending on these medications increased 49.5% in 2015, with an average cost per prescription of approximately $1799.

Compounded medication costs are also rising, with an average cost to payers of approximately $1769 per prescription in 2015.

These medications have seen a significant decrease in utilization due to education and management programs.

Express Scripts stated that their compound management solutions played a part in lowering spending on these products by 33.7% last year. Through managing compounded medications, clients reduce unnecessary costs, according to Express Scripts.

"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,” Dr. Nelson said. “Express Scripts proactively addresses compound use through physician and patient education and our prior authorization capabilities.”

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