By CYRIL TUOHY, managing editor of Risk & Insurance®
Narcotic analgesics, a powerful class of painkillers given to injured workers to ease the pain, declined as a percentage of total workers' compensation drug spending for the second consecutive year, a recent study found.
Narcotic analgesics declined to 33.6 percent in 2009, down from 34.1 percent in 2008 and 34.8 percent in 2007, according to the 2010 Workers' Comp Drug Spend Analysis, which is authored by Westerville, Ohio-based Progressive Medical Inc., a nationwide pharmacy benefits management company.
Net change in total workers' comp drug spending per injured party (not just for narcotics) declined 1.9 percent in 2009 over the year-ago period, the study also found.
One expert and the study's co-author pointed to stronger enforcement actions and the awareness of the overuse of narcotics as reasons for the decline.
"That means that the fines and the penalties against improper marketing practices taken against the manufacturer are effective," Jason Winters, manager of clinical services for Progressive Medical, said.
Painkiller brands belonging to the class of narcotic analgesics, the top medication category in workers' comp, include OxyContin, Actiq and Fentora. In 2008, Frazer, Pa.-based Cephalon Inc., the maker of Actiq and Fentora, paid $425 million to settle claims that it engaged in illegal marketing practices.
Actiq and OxyContin together make up about $1 of every $8 spent on workers' comp, said Winters. About $4 billion is spent every year in the United States on drugs related to workers' comp.
Of the top five medication categories in workers' comp, narcotic analgesics are the most problematic. They can lead to addiction long after a worker's injury has healed.
GENERICS MAKE INROADS
Gains made by the use of generic medications also contributed to the declining trend revealed in 2009, the study found.
The percentage of overall prescriptions filled with generics increased to 68.6 percent of products sold in 2009, up from 67.2 percent of products sold in 2008, the report found.
When generics were available for a prescribed brand-name product, the generic was used as a substitute 94.6 percent of the time, up from 93.4 percent in 2008.
Average wholesale price inflation in 2009 accounted for an 8.1 percent increase in the list of brand-name medications and a 0.2 percent increase in the list prices of generic medications.
Though 63 percent of workers' comp medication expenses are for brand-name drugs, Winters estimated that the use of generics has shaved about 2 percent off the total amount of total drug spending in workers' comp in 2009.
"The conclusion is that there's a tendency for good signs in the generic dispensing area," he said.
New generics released last year included tramadol extended release, a long-acting narcotic; topiramate, an anticonvulsant; lansoprazole; a stomach-acid reducer; and leveltiracetam, another anticonvulsant.
The top five medication categories in dollars spent--narcotic analgesics, anticonvulsants, anti-inflammatories, antidepressants and muscle relaxants--remain unchanged since 2007, according to the study.
Anticonvulsants as a percentage of total workers' comp drug spending dipped to 12.4 percent in 2009, from 12.6 percent in 2008 and 12.1 percent in 2007, the report also found.
Nonsteroidal anti-inflammatory drugs as a percentage of total workers' comp drug spending also rose to 8.9 percent in 2009, from 8.3 percent in 2008 and 7.9 percent in 2007.
Antidepressants as a percentage of total workers' comp drug spending remained about the same at 7.9 percent in 2009, compared with 8.0 percent in 2008 and 7.8 percent in 2007.
Muscle relaxants as a percent of total drug spending rose to 7.4 percent in 2009, from 6.8 percent in 2008 and 6.5 percent in 2007, the report also found.
June 3, 2010
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