Express Scripts Research Shows Prescription Drug Utilization Declines for Payers of Workers' Compensation

Narcotics Still Remain Highest Cost Therapy Class; Comprehensive Fraud, Waste and Abuse Program Key to Reducing Waste

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Apr 22, 2013, 08:00 ET

ST. LOUIS, April 22, 2013 /PRNewswire/ -- Express Scripts' (NASDAQ: ESRX) industry-leading prescription management programs drove down utilization of prescription drugs for workers' compensation payers last year even though overall drug trend rose, according to new research released today in the Express Scripts 2012 Workers' Compensation Drug Trend Report.

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Narcotic analgesics, which once again accounted for the highest spend among therapy classes in workers' compensation, saw utilization decline 2.7 percent. OxyContin^®, which accounted for nearly 10 percent of the total drug spend, had a 6.1 percent drop in utilization, although at $132.50, it still represents the highest average cost per user.

Overall trend — a combination of spending on drugs and utilization of drugs — increased 2.9 percent in 2012, reversing two years of declines, driven primarily by a 10 percent increase in cost per user for antidepressants and dermatologicals, such as Lidoderm™, Flector™ and Voltaren™. Availability of new products or new product indications in the two classes greatly affected trend.

Tim Pokorney, pharmacist, and clinical director of workers' compensation at Express Scripts, noted that the findings demonstrate the need for effective prescription-drug management programs for workers' compensation payers.

"Payers need innovative solutions that help them drive the use of clinically equivalent, cost-effective generics that can help rein in their overall pharmacy spending," Pokorney said. "Express Scripts is uniquely positioned to offer payers better solutions by bringing together our complementary capabilities of the behavioral sciences, clinical specialization and actionable data."

Programs that help control utilization include Oral Fentanyl Intervention and Long-Acting Narcotics outreach to physicians. Express Scripts also offers step therapy, narcotics education for injured workers and physicians, Drug Utilization Review, Physician Peer-to-Peer, and formulary management programs.

One product that helps manage trend for clients is a communication program that encourages injured workers to use lower-cost generic equivalents. The product is based on the findings of an Express Scripts research pilot which demonstrated how injured workers who received a letter explaining how their prescription drug choices could help control the rising cost of healthcare were 60% more likely to choose a generic equivalent.

Preventing Abuse to Drive Down Costs

Express Scripts offers a comprehensive first-of-its-kind fraud, waste and abuse program for workers' compensation payers to better manage narcotic utilization. Narcotics comprise more than a third of the cost and utilization in workers' compensation, and given the potential for misuse and abuse, payers need a focused approach to managing their use.

"Our fraud program combines our unique data analytics with clinical expertise and investigative services in a proven solution that increases savings for payers and safety for injured workers by reducing narcotics misuse and abuse," Pokorney said

In the U.S., prescription drug overdoses result in 1.2 million emergency room visits and more than 15,000 deaths each year — more than cocaine and heroin combined.

"We look for patterns of behavioral red flags to find cases that may otherwise be missed," he said. "We leverage thousands of tips each year and constantly refine our algorithm and data identification process as we continue to enhance our offering."

The full Express Scripts 2012 Workers' Compensation Drug Trend Report is available at http://www.express-scripts.com/services/workerscompensation/.

About Express Scripts

Express Scripts (NASDAQ: ESRX) manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science^SM, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

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SOURCE Express Scripts