Inappropriate use of meds, age of claim driving comp pharmaceutical costs

Workers' compensation pharmaceutical costs continue to rise despite consistent decreases in injury rates over the past several years. According to one expert, employers and insurers must note these trends to rein in costs, mitigate risks, and improve care for injured workers.

A study by PMSI, a pharmacy benefit manager and provider of specialty services for the workers' comp market, found that drug costs increased by 5.4 percent in 2008 and represent approximately 14 percent of the total medical spending in workers' comp. Dr. Maria Sciame, director of clinical services at the firm, said many factors drive costs in the workers' comp market, including the inappropriate use of medication. She pointed to a PMSI study that evaluated more than 2,000 injured workers with drug therapy problems related to multiple prescribers, duplicate therapies, inaccurate doses, and inappropriate duration of therapy.

"Inappropriate medication utilization is a major concern," said Sciame, who will address rising pharmacy costs at the 18th Annual National Workers' Compensation and Disability Conference® & Expo Nov. 18-20 in Chicago at McCormick Place. "We have found that we can reduce those risks by identifying and alerting prescribing physicians on possible inappropriate prescription usage."

Use of Schedule II narcotics decreases among California injured workers (08/13/12)
IAIABC, ACOEM target state workers' comp agencies with opioid message (10/24/11)
Study shows increasing frequency, costs of physician-dispensed meds (09/06/12)
Opioids, physician dispensing continue to concern practitioners (02/25/13)
Opioids, physician dispensing are major concerns among WC payers (02/11/13)

Sciame said the problem can't be blamed entirely on price.

"The hottest trend in workers' comp right now is using multiple medications in the treatment of pain, thereby increasing utilization," she said. "Utilization management programs can help control some of those factors and working a workers' comp-specific pharmaceutical benefits manager can result in price mitigation."

Sciame said the age of a workers' comp claim is also significant factor driving pharmacy costs. Research by PMSI, she said, has shown that injuries older than three years account for more than 80 percent of workers' comp pharmacy spending.

Read more at the WORKERSCOMP Forum^TM homepage.

November 5, 2009

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