Opioids, physician dispensing are major concerns among WC payers

Drug spending among workers' comp payers is relatively flat. That's the good news. The bad news is that concerns about the issue, especially opioids, is increasing, according to a new survey by a pharmacy benefit consortium.

CompPharma conducted its ninth survey of senior executives at workers' comp payers about prescription drug management trends. It found that the overall trend rate -- total drug costs from all respondents divided by respondents' prior year drug costs -- was a negative 0.7 percent while the average inflation rate for each respondent was 0.6 percent. That represents the second year of a negative trend rate.

When asked for their opinions on a scale of 1-5, drug costs were rated a 4.1 or "more important than other medical costs." The respondents were concerned that drug costs would be more of a problem in the next 12 to 24 months than they are today, by a rating of 4.2.

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)
Feds decry use of marijuana despite state laws (01/07/13)
Opioids, physician dispensing continue to concern practitioners (02/25/13)

The survey also focused on cost drivers. When asked what was the biggest problem in workers' comp pharmacy management, the use of opioids and increased use of narcotics was the major vote-getter.

"For the second year we asked respondents to score their concerns about opioids in work comp. And consistent with results from last year, respondents judged opioids to be a very significant problem, giving it an average of 4.8, identical to responses in the 2011 survey," the report says. "This is the highest score for any survey question in the history of the survey, and a clear indicator of the level of the industry's anxiety over a problem it has yet to fully understand, much less address."

Physician dispensing of medications was also a top concern, according to the report. It noted that respondents considered this a more significant problem than they did last year -- 3.9 compared to 3.0 last year.

"Unnecessary physician dispensing drastically and artificially inflates the cost of workers' compensation pharmacy costs," according to the report.

Nearly all respondents identified these concerns about physician dispensing:

Patient safety; physician-dispensed drugs do not go through the drug utilization review process.
Potential duplicate therapy.
Higher cost due to repackaged drugs priced above the same medications at retail stores.
Unnecessary medications or medications not related to claimant's injury.
Extended disability duration.
Higher overall medical cost.

In an effort to contain drug costs and address opioid issues, respondents generally have implemented and upgraded various programs. In addition to improved reporting and streamlined electronic processes, "over half had done extensive work to address opioid/narcotic prescribing, utilization and monitoring," the report says. "Half of all respondents utilized a urine drug-testing program to monitor claimant compliance."

Pharmacy management has changed "dramatically" in the nine years of the survey, according to the report. Where the concern had been about the price of a pill and size of the retail pharmacy network to today's concerns about opioids and other issues, there has been a "remarkable increase in sophistication and understanding."

However, the authors say payers' level of concern about pharmacy management is still high.

"It can be difficult to remember that drug costs are relatively flat," the report concludes. "With inflation running less than two percent, one could be forgiven for thinking payers believe they have drugs under control. Yet payers' evident level of concern, the active and ongoing efforts to improve results, the pressure on PBMs to deliver better penetration and lower costs, and payers' interest in new programs such as UDT are clear evidence that few believe pharmacy is 'under control.'"

Read more at the WorkersComp Forum homepage.

February 11, 2013

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