Narcotics Significant Factor Driving Rise in WC Drug Costs
Narcotics account for nearly one-quarter of all workers' compensation prescription drug costs, according to a recently published study by the National Council on Compensation Insurance.
Few members of the medical community would object to the use of narcotics to treat severe, chronic, cancer-related pain. However, according to the researchers, the medical community seems divided over the suitability of narcotics to treat other forms of pain, such as those resulting from the majority of workers' comp injuries. One thing that everyone can agree on, the study noted, is that narcotics have become a significant driving factor in recent years behind the rising costs of pharmaceuticals used in workers' comp.
About the study.
The Drug Enforcement Administration defines a narcotic as opium, opium derivatives, and their semi-synthetic substitutes, which are used therapeutically to treat pain, suppress cough, alleviate diarrhea, and induce anesthesia. The NCCI study examined the use and prescribing patterns of this controversial category of drugs in workers' comp.
For the study, NCCI used information from a sample of claims data provided by select carriers for injuries that occurred between 1994 to 2007, and services that were provided from 1996 to 2007, evaluated as of July 1, 2008. The prescription drugs included in the data were all drugs identified with a National Drug Code or with a carrier-specialized drug code. Therefore, researchers said not all workers' comp drug costs were included in the study. For example, the study was not able to include drug costs that were bundled with other services and included in codes such as Hospital Revenue Codes, Healthcare Common Procedure Code System, or Current Procedural Terminology.
Among the highlights of the study, NCCI researchers found that:
- Narcotics account for nearly 25 percent of all comp drug costs. Researchers said that this share has been relatively constant since 2000, with a slight aberration in 2005. The timing of this temporary increase, the study noted, coincided with the voluntary removal of Vioxx® and Bextra® and the release of expanded risk information for Celebrex®. The study concluded that the proximity of this aberration with these events suggested that workers' comp doctors might have been, at least temporarily, prescribing narcotics as alternatives to these drugs.
The active ingredient oxycodone, which includes the popular painkiller OxyContin®, represents the largest share of narcotics costs at 37.4 percent, followed by hydrocodone at 23 percent, and fentanyl, which includes one of the most expensive drugs -- Duragesic®, at 11.8 percent.
- The narcotics share of drug costs increases as claims age. Researchers found that the narcotics share of workers' comp prescription drug costs increases steadily with maturity until about the eighth relative service year when it levels off.
The study noted that high-cost prescriptions -- drugs for which the average paid dollars per prescription are greater than $75 -- grow from a relatively small portion (9 percent) of narcotics prescriptions in the first relative service year to 45 percent of all narcotic prescriptions in the 12th relative service year.
- Narcotics costs per claim vary by state with apparent regional differences. Midwestern states tend to be lower cost states and coastal states tend to be higher cost, researchers said. The study concluded that utilization, not price, explained the majority of the cost differences between states.
- Narcotics are used mostly for back injuries in workers' comp. The study found that more than 44 percent of dollars paid and 32 percent of prescriptions written for narcotics are for claims involving back injuries. Researchers noted a California Workers' Compensation Institute study from 2008 that found that doctors prescribed opioids in 25 percent of all back injury cases without spinal cord involvement. These back injuries were typically sprains and strains.
- Narcotics use early in the life of claims is increasing. Researchers said the increase in the percentage of claims receiving narcotics within 36 months of injury points to increased utilization of narcotics in workers' comp.
Researchers noted that the Food and Drug Administration is in the process of establishing a federal program to ensure the safe, appropriate use of narcotics. According to the study, The New York Times discussed this future program designed to control "the prescribing, dispensing and distribution of extended-release [narcotics]." One aim of the initiative, researchers said, would be to ensure that only physicians who are properly trained in the safe use of narcotics can prescribe them.
In addition, NCCI noted that several recent articles and studies also point to increased scrutiny of narcotics use. Researchers said that in at least one state diagnoses of "chronic pain" or "failed back syndrome" virtually guarantee that the claim involves over-prescription of narcotics because these are the diagnoses that justify the use of narcotics. The study pointed out that additional research has found that overuse of narcotics has "shown adverse effects on the overall well-being and treatment of injured parties."
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January 28, 2010
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