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Workers’ Comp Drug Costs Decrease

| Aug 15, 2018 | Workers' Comp |

According to CompPharma’s 15th Annual Survey of Prescription Drug Management in Workers’ Compensation, pharmacy costs associated with workers’ compensation benefits have decreased by $1.1 billion during the past 8 years.

Joe Paduda, president of CompPharma, LLC, said, “Pharmacy is no longer the fastest-growing segment of work comp medical expenses. Work comp payers, regulators and PBMs have been extremely successful in reducing drug spending, much more successful than other payers. Survey respondents reported a 9.84% decline in total pharmacy costs during the past year, while the national spending across all payer types decreased by a paltry 2.1%.”

Of the 29 respondents, 12 gave credit to programs for the spending decrease, while 8 others cited fewer opioid prescriptions. Paduda said, “The latter makes sense as workers’ compensation patients who take opioids usually also take other medications, often to combat opioid side effects.”

One major take away from the survey was that, “many respondents did NOT want to abandon their internal formularies in favor of a one-size-fits-all blanket formulary. These payers noted patients are all different, their needs evolve throughout the course of treatment and recovery, and therefore their pharmacy needs would change as well. While they were in favor of managed (state-mandated) formularies for initial fills, they want flexibility to adapt to the patient’s condition and needs without putting undue burden on the prescriber and pharmacy to comply with prior authorization requirements.”

Although opioids can successfully treat pain, payers remain focused on opioid management. Paduda noted that the focus is because “they know that far too many patients still use opioids and are concerned about the risk of addiction and dependency.”

This new trend in the Pharmacy Benefit Management (PBM) industry has raised some concerns among respondents. According to Paduda, “Some payers believe the large PBMs will be less willing to compete for their business and less willing to customize programs for them. At the same time, some see the potential that more resources and better buying power will help them further reduce costs.”

CompPharma’s survey analyzed pharmacy cost data available for 2017. The data included responses from 29 workers’ compensation insurance carriers, third-party administrators, self-insured employers, and state funds.

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