Workers' Compensation Prescription Drug Spend Increased 1.9 Percent in 2014, Stabilized by Effective Utilization Management Programs

Rising Prescription Prices for Compounded Medications Still a Concern

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Apr 21, 2015, 08:30 ET

ST. LOUIS, April 21, 2015 /PRNewswire/ -- Workers' compensation pharmacy spending increased 1.9 percent in 2014, as a 5.4 percent decrease in utilization helped offset a 7 percent increase in the cost per prescription, according to new data released today by Express Scripts (NASDAQ: ESRX).

The 2014 Express Scripts Workers' Compensation Drug Trend Report discusses the overall pharmacy trend as well as in-depth research on opioid use among injured workers.

Opioid Management Mitigates Spend Increases

The modest increase in overall pharmacy spend demonstrates the effectiveness of utilization management programs, such as those which drove down injured workers' opioid utilization nearly 11 percent in 2014.

This decrease in utilization balanced an 11.5 percent increase in the average cost per prescription. As a result, total spending on workers' compensation opioids remained flat (-0.5 percent) in 2014, at a per-user-per-year cost of $487.59.

"As drug prices continue to increase, payers now more than ever are looking to contain costs by implementing effective programs that ensure safe and appropriate use of opioids," said Jennifer Kaburick, RN, senior vice president, Workers' Compensation Product, Compliance and Strategic Initiatives.

Express Scripts leverages data to develop innovative solutions to meet these needs. For example, the Express Scripts Morphine Equivalent Dose (MED) Management program allows clients to set maximum threshold levels for the amount of opioid medications an injured worker can fill. Amounts exceeding MED program levels undergo a review process by the client before the medication is dispensed.

Patients receiving an MED of 100 milligrams or more per day had a nine-fold increase in overdose risk. Express Scripts' research found that patients with work-related injuries longer than 15 years exceeded the MED of 120 milligrams per day on more than half of the days for which opioid medications were being filled.

"Although older injuries may require higher doses of opioids because the patient has become tolerant to previous doses, patients receiving an MED of 100 milligrams or more raises serious concerns about the potential of addiction and abuse," said Brigette Nelson, MS, PharmD, BCNP, senior vice president, Workers' Compensation Clinical Management at Express Scripts. "Better management of opioid use among injured workers helps to reduce abuse, limit addiction and control costs."

Combating Rising Compounded Medication Costs

For the second year in a row, compounded products were one of the top 10 costliest therapy classes for workers' compensation payers.

Unsustainable pricing greatly impacted the overall trend, and the average cost of compounds per workers' compensation prescription in 2014 was $1,696.99.

According to Express Scripts' research, pharmacies that compound more than two-thirds of their total prescriptions increased their prices 51.5 percent in 2014. Low-compounding pharmacies — or those than compounded less than 67 percent of their total prescriptions — averaged only a 9.7 percent price increase.

At the point of sale, payers have the option of reviewing all compounds for authorization. Retrospectively, Express Scripts communicates to physicians and injured workers encouraging the use of commercially available, cost-effective alternatives where appropriate.

Express Scripts research found that 10 percent of compound utilizers did not receive a traditional prescription before receiving their compounded medication — that is, they used a compounded medication as the first prescription for their injury.

"This raises the question of why first-line therapies were not tried," Nelson said. "While accommodating needs for a patient who cannot ingest or is allergic to available alternatives is appropriate, there is no clinical evidence that compounded medications are more effective than FDA-approved, commercially available drugs."

When payers implement the physician communications program, 46.6 percent of their injured workers discontinued filling unnecessary compounded medications.

Other key findings of the Workers' Compensation Drug Trend Report include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), used in treating pain and inflammation, increased 13.4 percent to reach $158.33 per user per year.
Antidepressants and dermatologicals decreased 19.6 percent and 10.9 percent, respectively.
While specialty medications represent less than 1 percent of all medications used by injured workers, spending on these drugs increased 30.4 percent between 2013 and 2014, largely driven by expensive medications to treat hepatitis C.

The Express Scripts 2014 Workers' Compensation Drug Trend Report is available at http://Lab.Express-Scripts.com. Printed copies also will be available at the Risk Management Society (RIMS) Conference, April 26 to April 29 in New Orleans, in booth #147.

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.

MEDIA CONTACT:
Ellen Drazen
Office: 314-684-5355
[email protected]

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SOURCE Express Scripts