For years, prescription drug costs in the workers’ compensation arena have outpaced the costs of any other medical services provided to injured workers. Only recently – within the last few years – have the cost of drugs begun to level off, largely due to better management of prescription drug costs by workers’ comp pharmacy benefit managers (PBMs) and increased usage of generic drugs. Yet, for many payers, prescription costs can still represent more than 15 percent of their total medical spend.
Recent workers’ comp industry studies emphasize that the continued increase is due to drug utilization and most notably, from the use of off-label prescriptions for treating chronic pain cases. In these cases, a small portion of a claims population drives the largest percentage of a payer’s total drug costs.
“Our research has shown that in most payer environments, less than 10 percent of injured workers receiving prescriptions can account for more than 55 percent of their total drug spend,” says Daryl Corr, President of Healthesystems, a specialty provider of medical cost management solutions for the workers’ compensation industry. Therefore, having an effective strategy to aggressively focus on this small group of cases can produce big results.
As stated, the increased use of generic drugs ...read more