Workers' Compensation Drug Spending Drops


Pharmacy benefit manager reduced prescription drug spending among injured workers.

A new study conducted by Express Scripts found that the pharmacy benefit manager significantly lowered spending on prescription drugs through various methods.

The 11th edition of the Workers’ Compensation Drug Trend Report indicated that Express Scripts lowered drug spending for workers’ compensation payers by 7.6% in 2016.

"In a year when many payers wrestled with drug price increases that dominated the news, Express Scripts protected clients from this impact," said Brigette Nelson, PharmD, senior vice president of workers' compensation clinical management at Express Scripts. "By practicing pharmacy smarter, we helped clients balance appropriate care for injured workers while keeping costs down."

The authors found that opioids cost $391.35 per user per year. Not only were opioids the most expensive class of drugs, they also accounted for 13 out of the 25 most used drugs, according to the report.

However, opioid use among those receiving workers’ compensation has been declining for the past 6 years. In 2016, the trend was observed to decrease 13.4% due to clinical solutions, aggressive clinical management, and regulatory trends, according to Express Scripts.

The observed decrease in prescription drug spending was primarily driven by lessened opioid use, providing evidence that steps are being taken to combat the opioid epidemic. Express Scripts has developed point-of-sale programs, physician outreach, patient education, and progressive analytics, which has allowed payers to reduce concerns over safety and costs associated with opioid use, according to the release.

Additionally, the CDC has taken steps to revisit best practices when dealing with opioid prescriptions. States have considered or implemented formularies that limit opioid prescriptions to drive down use.

The report also found that spending on compounded medications decreased 28.6% in 2016. Although these drugs are costly, effective management strategies led to a reduction in unnecessary costs and wastes associated with the drugs, according to Express Scripts.

When prescription drugs are dispensed directly to injured workers, additional costs may be incurred due to repackaging or relabeling. Those drugs are also not subject to the same prices as pharmacy-dispensed drugs and may present safety concerns, which suggests that other methods should be pursued, the report noted.

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

In 2016, the average costs of physician-dispensed drugs was $219.25, while it cost only $110.16 for those dispensed at a pharmacy. These findings show that Express Scripts’ Workers’ Compensation customers paid an additional $109 for medications that were also not subject to pharmacist review, according to the report.

Filling prescriptions through costly methods results in additional costs without added benefit, resulting in waste. Long-term prescriptions for these patients sent through the mail cost payers 15% less than those purchased at a retail pharmacy, and is also convenient, according to the report. These findings highlight the benefits of mail-order pharmacies for both patients and payers.

Spending on specialty drugs were observed to stabilize in 2016 among injured workers. Although these drugs account for less than 1% of all drugs used by this population, the high costs require increased monitoring.

"Managing specialty spend requires clinical expertise and strategic guidance," Nelson said. "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."

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