While the average cost per workers compensation claim increased in 2014, the number of prescriptions per injured worker and the average morphine equivalent dose per script declined, Coventry Workers’ Comp Services said Tuesday.
In 2014 the significant increase in generic AWP was the primary driver of increased prescription cost per claim. The most heavily impacted drug classes include narcotics, NSAIDs, and muscle relaxants.
Meanwhile, the number of prescriptions per injured worker decreased 5%, narcotic utilization decreased 7.4% and the average morphine equivalent dose per script decreased 4.5%, according to the analysis. Medications with the most significant decreases were hydrocdone-acetaminophen (Vicodin®) and oxycodoneacetaminophen (Percocet®), both narcotics. The rescheduling of hydrocodone combination products from a Schedule III drug to a Schedule II drug in 2014 contributed to the decline in utilization. Vicodin®, the #1 prescribed medication had the largest decrease in utilization over the last three years with a 7.8% decrease.
The number of prescriptions increases as the claim ages, typically driven by adjuvant therapies such as anticonvulsants and antidepressants that support pain management and lessen narcotic burden.
Generic utilization increased 5.9% to 82% last year, according to the analysis. But the inflated AWP drove up costs of frequently prescribed generic medications, resulting in an increased prescription cost per claim. The impact of this year’s inflated AWP has been noted throughout the report. The release of generic Cymbalta® in 2013 drove the significant reduction in spend for antidepressants
According to Coventry, compound drugs accounted for 7.7% of all managed drug spending and 28.1% of all unmanaged drug spending in 2014, up from 4.5% and 20.1%, respectively, in 2013. “The rising use of compound medications in workers compensation has created greater risks to injured worker safety and has become a cost burden on the system,” the analysis states. Despite direction from medical guidelines, compound utilization as a primary line of therapy continued to grow. In addition,new formulations were being used to target gaps in medical guidelines and formularies. In California the percentage of workers receiving compounded drugs in unmanaged cases was around 10%, and in managed cases 2%.
More states are adopting closed formularies in an effort to control pharmacy cost and utilization. Three states have already taken steps to introduce workers’ compensation closed formularies in 2015: Arkansas, Tennessee, and California. If adopted, the total number of states with implemented closed formularies and/or “preferred drug lists” will be eight.
It’s no secret that workers’ compensation patients are frequently being prescribed narcotics and other medications that can create risk for dependence and misuse. Urine Drug Monitoring (UDM) is a clinical decision-support tool that can help reduce these risks, ensure compliance with the prescribed drug regimen, and promote patient safety. However, incorporating UDM into the narcotic management of injured workers has not been an easy task for payors. Many of the medical treatment guidelines commonly referenced in workers’ compensation do not provide enough detail or have conflicting recommendations concerning the frequency or type of testing.