Survey: Opioids, physician dispensing are key issues among stakeholders

Drug costs trended lower for many workers' comp payers in 2010. Nevertheless, executives from insurance and third-party administrators have more to say about challenges in workers' comp pharmacy management than they have in the eight years that a prescription drug management survey has been conducted.

By Nancy Grover

The findings are included in the latest report from CompPharma LLC, a workers' comp pharmacy advocacy and education firm. The annual survey sheds light on the concerns of workers' comp payers, the steps they are taking, and the effectiveness of those actions.

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The Prescription Drug Management in Workers' Compensation -- Eighth Annual Survey Report focuses on the multibillion dollar issue in the workers' comp system. It includes responses from 20 insurance and TPA executives and managers interviewed in the fall of 2011.The respondents represent carriers and TPAs with 2010 drug expenses ranging from $1.7 million to $176 million.

The survey found inflation/trend in drug costs was actually down by 0.9 percent in 2010. Additionally, the average inflation rate for each respondent was at minus 1.8 percent.

Despite the encouraging news, drug costs remain a concern among workers' comp payers. "In the eight year we've been conducting the survey, we haven't seen as much change in the market as we encountered in 2010. Respondents are keyed in on opioids; frustrated with the cost, clinical problems and management issues inherent in physician dispensing; working diligently to develop programs -- with and without their PBMs -- to address multiple individual issues; monitoring and measuring the impact of these initiatives; and all this despite experiencing lower drug costs year after year," the report says. "This is remarkable."

Narcotics. The recent attention on opioids in the workers' comp system is not lost on payers. In fact, respondents mentioned it throughout the survey even when responding to unrelated questions.

"On the 1 to 5 scale, respondents judged opioids to be a very significant problem, giving it an average of 4.8," the report says. "This is the highest score for any survey question in the history of the survey."

The survey also asked, "For claimants who are taking opioids or other narcotics, how much of a concern is dependence or addiction?" Sixty percent scored it a 5, indicating they were extremely concerned about dependency or addiction.

Respondents provided "long and thoughtful answers" to the question, "Why do you think opioids are an issue in workers' comp?" Their answers included:

Opioids provide only temporary relief of pain.
They cause major dependence and even death.
They are addictive and don't necessarily control pain.
They may increase disability.
Chronic use may lead to other risks, such as sleep apnea.

Physician dispensing. Medications dispensed directly from physicians' offices accounted for approximately 28 percent of pharmaceutical costs in the workers' comp system in 2009, according to NCCI. Among respondents, the practice raises several concerns.

"Physician dispensing unnecessarily creates a health and safety risk for the injured worker receiving those prescriptions," according to the survey. "Injured workers often see multiple physicians for their work-related injuries, in addition to their group health doctors, who may each prescribe multiple medications."

In addition to the risks to the injured worker are the costs to payers. The report notes the practice "dramatically and artificially inflates the cost of workers' comp pharmacy costs" with the drugs typically costing three or four times the amount of the same medication filled by a retail pharmacy.

In a change from last year, the respondents did not express any positive feelings about the practice. The majority viewed physician dispensing as "little more than a way for physicians to make money with questionable benefits for patients, and fraught with risks due to greater risk of adverse drug interaction."

Controlling drug costs. More than two-thirds of respondents said they have implemented major changes to their programs in the last year with more emphasis on strengthening clinical programs, especially opioid use.

Among the responses to the question of what programs they have initiated were:

Created a program that looks at first-time narcotic users, chronic narcotic users, and high-dollar cost products being used, as well as antidepressants and antipsychotic medications.
Decreased reimbursement rate and controlled the formulary and utilization. Tightened up the formulary so what is covered is really industrial-related.
Imposed stricter formulary controls.
Implemented a narcotic focus program.
Began clinical escalation alerts when drugs fall outside of the formulary.

"This was the first year the answers indicated widespread rigorous measurement and evaluation," the report says. "Clearly payers are much more sophisticated this year."

Read more at the WorkersComp Forum homepage.

March 5, 2012

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