Chronically injured workers – those who remain injured for four years or more – represent only 17 percent of all injured workers, but account for 45 percent of all workers’ compensation prescriptions, and nearly 65 percent of all pharmacy costs.
This means that the pharmacy needs of the chronically injured worker represent 65 percent of the savings opportunity, according to PMSI, a Florida-based provider of pharmacy and specialty products for workers’ compensation.
PMSI conducted a pharmacy database analysis “zeroing-in on the savings opportunities within workers’ compensation claims.” The analysis focused on the first-fill prescription, or the initial pharmacy prescription immediately following an injury and before the claim is made to the insurer. The analysis also took into account the ongoing costs associated with chronically injured workers.
The review found that only 35 percent of injured workers who receive a prescription fall into a “first-fill scenario/” That’s less than 18 percent of total prescriptions and less than 5 percent of the total savings potential.
According to PMSI, the pharmacy database studied represents nearly 12.5 percent of the total workers’ compensation annual drug spend.
PMSI says this analysis “uncovers the need for a major shift in focus within the industry in relation to areas of potential cost savings.” PMSI recommends that pharmacy programs and services do a better job of managing network and prescription utilization for the chronically injured worker.
Overall, according to PMSI, a balanced pharmacy program must have an appropriate focus on first-fill but a stronger focus on the chronically injured worker.
“The workers’ compensation community has been enthusiastic about the cost savings potential of first fill,” said Nick Page, vice president of Pharmacy Services for PharmD. “However, our analysis finds that this first-fill prescription is a very small percentage of overall costs and the real cost savings opportunity lies in clinical pharmacy management for the chronically injured worker on long-term medication.”
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