Drug Spending for Workers' Compensation Rose 2.2% in 2015

American workers’ compensation payers experienced a 2.2% increase in pharmacy spending in 2015, but effective management programs helped lower injured workers’ drug utilization by 2.6%.

American workers’ compensation payers experienced a 2.2% increase in pharmacy spending in 2015, but effective management programs helped lower injured workers’ drug utilization by 2.6%, offsetting the 4.4% increase in average cost per prescription, according to a new report by Express Scripts.

As the workers’ compensation marketplace becomes more complex, careful management of medication therapy, drug utilization, and injured-worker safety is critical, the company noted.

The 10th edition of the Express Scripts Workers’ Compensation Drug Trend Report found that opioid and compound drug management continue to be a focus for this market segment, and the rising cost of specialty medications is becoming a key budgetary challenge for these payers. Opioids are the most expensive class of medications for occupational injuries. Express Scripts’ opioid management programs held spending for opioids down by nearly 5% as utilization decreased by almost 11%. On average, injured workers got 2.91 opioid prescriptions per year, a figure that is down from 3.33 prescriptions in 2014.

Brigette Nelson, MS, PharmD, BCNP, Express Scripts senior vice president of workers’ compensation clinical management, said the company had created solutions to mitigate the potentially harmful effects of opioids to patient safety. The company introduced a proactive and retrospective look at opioid prescribing using Morphine Equivalent Dose (MED) point of sale and prescriber outreach solutions, and injured worker narcotic education outreach to create a comprehensive approach to injured workers’ opioid use that identifies escalations in the dose that may be problematic. Express Script clients who used the company’s MED Management program experienced a 46.1% drop in patients receiving opioids and a 51.5% drop in prescriptions with MED higher than 120 mg/day within one year.

The report also noted that specialty medications, which represent less than 1% of all medications used by injured workers, are a source of rapidly rising prices. Spending on specialty medications increased 49.5% in 2015, with an average cost-per-prescription of $1799.02—10 times the cost of a typical traditional medication. Antiviral medications to treat hepatitis C and HIV were the main drivers of the increased overall specialty drug spending, the report noted. Harvoni (ledipasvir/sofosbuvir), a specialty antiviral used treat hepatitis C, was one of these high-cost medications, but low use of these medications among injured workers minimized the effect.

Compounded medications were among the top 10 therapeutic drug classes in 2015, with costs to payers for these drugs averaging $1769.45 per prescription. Spending on these products was reduced by 33.7% through better education and management programs, Dr Nelson said. Because compounded medications are not reviewed by the FDA for safety or efficacy, they may pose unnecessary risks for injured workers and so are not considered first-line therapies within workers’ compensation treatment guidelines.