Workers’ Compensation payers—the insurance providers that provide the policies employers buy—saw their pharmacy expenses decrease by 11 percent in 2016. This was not the first year that pharmacy costs decreased. In 2015, payers spent 8.7 percent less on pharmacy drugs than they did the previous year.
This data comes from reports published by CompPharma, a pharmacy benefit manager that conducts a survey of Worker’s Compensation payers. It surveys insurance providers who offer Workers’ Compensation insurance, representatives of state funds, self-insured employers, and third-party Workers’ Compensation administrators to obtain relevant industry data each year.
The decrease in pharmacy costs in 2015 and 2016 is part of a larger ongoing trend. Pharmaceutical drug costs for Workers’ Compensation payers have steadily dropped over the past seven years and are now 22 percent lower than they were in 2010. According to the most recent CompPharma report, Workers’ Compensation payers spend between $3.6 and $4.1 billion on pharmacy expenses annually.
Reasons for Decrease
A primary reason behind the decreased pharmacy costs is the dropping price of opioid medication. In 2016, opioid costs dropped by 13.3 percent. Alongside this lower cost, pharmacy spending decreased because injured workers are using opioids less often to treat their pain after workplace injuries.
Other reasons cited for decreased pharmacy spending include:
Lower claim volumes
A decreased use of medication compounds among injured workers
Multiple clinical management changes that make more efficient use of available funds
One of the clinical management changes is the increased adoption of urine drug testing (UDT) compliance programs. In 2011, half of the payers surveyed by CompPharma responded that they use a formal UDT program to ensure claimants are using their drugs as prescribed. Today, 66 percent of payers use this type of testing.
Decreased Opioid Dependence
The United States is currently facing what has been labeled as an opioid epidemic. Because of this, reducing opioid use has been a recurring goal for Workers’ Compensation payers. The decrease in opioid use and its effect on payer pharmacy costs is partly due to the payers’ efforts to ensure that workers use opioids responsibly. These efforts include:
Coordinating with doctors and pharmacists to review claims
Creating programs that help injured workers handle their pain without opioids
Testing drugs more rigorously
Attempting to identify potentially risky prescription practices before they harm patients
Another study of drug prescriptions in Workers’ Compensation claims underscored CompPharma’s findings. This 2016 study, published by the Workers’ Compensation Research Institute (WCRI) found that in most of the states surveyed, there was a noticeable decrease in the amount of opioids prescribed per Workers’ Compensation claim.
Philadelphia Workers’ Compensation Lawyers at The Law Offices of Jeffrey S. Gross Help Injured Workers Seek the Benefits They DeserveIf you or someone you love has been injured on the job, contact a Philadelphia Workers’ Compensation lawyer at the Law Offices of Jeffrey S. Gross. Call 267-589-0090 or complete our online form to schedule an initial consultation. Our offices are located in Philadelphia, allowing us to serve Pennsylvania and New Jersey.