Here’s What’s Happening with Drug Costs in Workers’ Compensation

April 7, 2016

Overall pharmacy spending increased 2.2 percent for U.S. workers’ compensation payers in 2015 due to higher drug prices, according to a report by benefit manager Express Scripts. That overall increase was a function of 2.6 percent lower injured workers’ drug utilization last year being offset by a 4.4 percent increase in the average cost per prescription.

Also, opioids continue to be the costliest drugs for injured workers although overall spending on opioids in workers’ compensation cases was down due to lower utilization, according to the report based on the firm’s data.

The Express Scripts Workers’ Compensation Drug Trend Report evaluates year-over-year changes in medication costs and utilization for injured workers.

At $450.90 per-user-per-year, opioids continue to be the costliest class of medications for occupational injuries. Yet, overall spending for opioids decreased nearly 5 percent as utilization decreased by almost 11 percent, Express Scripts said. On average, injured workers received 2.91 opioid prescriptions per year – down from 3.33 prescriptions in 2014.

Express Scripts said workers’ compensation payers continue to be focused on opioid and compound drug management even as they grow increasingly worried about and the rising cost of specialty medications.

Impact of Specialty Medications Realized in 2015

While specialty medications represent less than 1 percent of all medications used by injured workers, rapidly rising prices are a major concern, according to the report. Spending on specialty medications increased 49.5 percent in 2015, with the average cost per prescription reaching $1,799.02 – nearly 10 times that of a typical traditional medication.

Antiviral medications to treat hepatitis C and HIV were primary drivers of the annual increase in overall specialty drug spending, the report found. Spending in the antiviral class increased 85.1 percent, heavily influenced by a 66.7 percent increase in cost per prescription, Express Scripts found.

Compounded Medication Costs

For the third consecutive year, compounded products were among the top 10 therapy classes as ranked by total spending in 2015.

The cost to payers for compounded medications averaged $1,769.45 per prescription in 2015.

However, according to Express Scripts, better education and management programs have led to a decrease in utilization. Express Scripts said its compound management programs helped lower spending on these products by 33.7 percent last year.

Headquartered in St. Louis, Express Scripts provides pharmacy benefit management services.

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