Pharmacy Cost in Workers’ Compensation Continues to Fall: CompPharma Survey

Workers’ compensation payers saw an average 11 percent reduction in their pharmacy spend in 2016, driven by a 13.3 percent reduction in opioid cost, according to an annual survey by pharmacy benefit manager CompPharma.

CompPharma’s 14th Annual Survey of Prescription Drug Management in Workers’ Compensation analyzed pharmacy cost data from 2016 of 23 workers’ compensation insurance carriers, third-party administrators, self-insured employers and state funds.

Total workers’ compensation annual pharmacy spend is approximately $3.6 to $4.1 billion, according to the report.

Survey results indicate drug costs have fallen in five of the last seven years; the spend today is 22 percent lower than it was seven years ago.

Last year’s CompPharma report, which analyzed 2015 data from 30 payers, showed an 8.7 percent drop in spending on drugs in 2015.

As key drivers of lower spending, payers cited lower claim volumes, decreased usage of opioids and compounds, and various clinical management changes as key drivers of lower spending.

“Clearly the efforts of workers’ comp regulators, payers, desk-level staff, PBMs and prescribers have paid off,” said Joseph Paduda, president of CompPharma. “While we have much left to do, this represents a dramatic improvement in the lives of thousands of patients.”

Working with their pharmacy benefit managers, payers cut one of every six dollars in opioid spend, a result the report calls a “truly remarkable.” In contrast, across all payer types, pain medication use declined by a scant one percent.

Respondents were again asked if they use a urine drug testing (UDT) program. Six years ago, half utilized a “formal” UDT program to monitor claimant compliance; today two-thirds of respondents said they do.

While opioid costs are declining, the survey found payers remain concerned about the risk of opioid addiction or dependency. Most are continuing to refine programs to help patients address pain while minimizing use of opioids, relying on physician and/or pharmacist review of claims, early identification of potentially risky prescribing and increased use of drug testing, according to the report.

A study by the Workers Compensation Research Institute (WCRI) released in June 2016 found “noticeable decreases” in the amount of opioids prescribed per workers’ compensation claim in a majority of 25 states studied.

In contrast, payers say they are less concerned than they were about compound drug utilization.

The author cautions that a payer’s drug cost is not the same as drug price. Price is one component of drug costs to a payer along with the number and type of drugs.

Source: CompPharma’s 14th Annual Survey of Prescription Drug Management in Workers’ Compensation