Study: Pharmacy Costs in Workers' Comp Jump 6.5 Percent in 2009
By CYRIL TUOHY, managing editor, Risk & Insurance®
Average pharmacy spending per injured worker jumped 6.5 percent in 2009 from the year earlier due to an increase in prescription drug prices and changes in drug utilization, according to a new report.
The 6.5 percent rise was due mainly to a 4.7 percent increase in prescription drug prices and a 1.7 percent increase in drug utilization, the survey also found
Maria Sciame, executive director of clinical services for PMSI Inc., the Tampa, Fla.-based pharmacy benefits management company that released the survey, said the slight price increases came as no real surprise and that many factors affect total pharmacy spending.
"A number of complex factors drive pharmacy spend," Sciame said.
On the pricing side of the equation, the increase in prescription drug prices was due to the 6.3 percent rise in the average wholesale price set by the manufacturers, and the much smaller increase -- 3.6 percent -- in mail order utilization.
Mail order options, which allow injured workers to order up to a 90-day supply of medications instead of a 30-day supply, reduce administrative costs, cut the number of billing cycles and trim dispensing fees.
On the utilization side of the pharmacy spending equation, the days of supply per prescription was up, to 28.2 days in 2009, from 27.6 days in 2008, in increase of 2.2 percent, the survey found.
The driver of days of supply changes was a 2.9 percent increase in retail pharmacy days of supply per injured worker, the survey found. The jump was related to the longer use of prescription drugs as chronic pain injuries required longer treatment, the report also said.
The overall increase in days of supply per injured worker was tempered by an 11.6 percent decrease in mail order pharmacy days of supply, the survey also found.
Authors of the survey said changes in days of prescription drug supply can be associated with changes in physician prescribing patterns because of new drug releases, changes in treatment guidelines, standards of care and evidence-based medicine.
The age of the claim and changes in prescription per injured worker also affect utilization rates. The survey also found a 1.2 percent decrease in 2009 in the average age of the claim, to 4.7 years, due to an increase in volume of new claims over 2008.
Generic drugs also played a bit part in keeping price increase to single digits. Since there were very few generics in 2009 with any impact on workers' comp, generic medications cut the average spend per injured worker by only 0.12 percent, or $2.31, in 2009 the survey also found.
The introduction of new brands had an even more limited impact on total spending, with a net increase of .09 percent, or $1.36 added to the average spent per injured worker.
It is the third year the company has issued the report, which is based on data collected from more than five million retail and mail-order pharmacy transactions from 2007 to 2009.
A separate study released earlier this year by the Westerville, Ohio-based pharmacy benefits manager Progressive Medical Inc. found that the net change in workers' comp drug spending per injured party declined by 1.9 percent in 2009 over the year-ago period.
July 16, 2010
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