Decreased Drug Spending in 2016

Workers’ compensation costs have steadily increased for years.  This is due in part to insurance premiums being on the rise for businesses.  Many factors contribute to the rise in premium prices, including the cost of medical services and prescription drugs.  The vast majority of workers’ compensation cases will involve some type of prescription drug treatment for the employee who has suffered a work-related injury. 

Opioid abuse is a widespread problem, with efforts being made across law enforcement agencies and the medical community to reduce the issue as much as possible.  Workers’ compensation systems have also started to recognize the problem and take important steps.  However, opioids are also some of the most expensive prescriptions with thirteen of the top twenty-five most expensive medications being types of opioids.  Although opioids can be an essential step in helping with pain management for an employee who has suffered a work-related injury, the CDC reports that the drugs are also highly addictive.  Some red flags for steps that could put a worker at heightened risk for opioid abuse are prescriptions that last longer than ten days or a second prescription, especially if written after thirty days.

One company has adopted strategies to address the opioid crisis including morphine equivalency doses.  They relate that payers who adopted the program saw a reduction of almost 25%.  The system involves point of sale review as well as drug utilization review to identify the use of long-acting opioids or therapy duplication.  This has also been combined with a notification system that provides notice to the payer if opioids fill exceeding certain thresholds.  Patient education as well as a program to discuss prescribing patterns with medical professionals to help reduce dangerous drug combinations.  Prescribers should be encouraged to prescribe the lowest dose for the shortest duration, optimally fewer than three days.  Prescribers should also be made aware of coordinating efforts with law enforcement and providers where necessary to help with addiction and fraud.  Using these techniques, there was a decrease in opioid spending of 13.4% and an overall decrease in drug spending of 7.6% in 2016.

Physician dispensed medication could be a source of increasing cost in the future as well.  When physicians dispense medication directly to the patient, there is no oversight at the pharmacy, which puts the injured worker at much higher risk of potential drug interaction.  This is especially true when a worker is seeing more than one doctor.  Drug interactions or addiction will keep the employee out of work longer and could have costly implications for him or her for the rest of his or her life.  Drugs delivered directly to a worker’s home, however, could save money by reducing costly channels such as those sometimes found at a retail pharmacy.

If you have questions about the workers’ compensation system and how your business should work to help reduce costs, you need to talk to an experienced attorney.  Call us today at (714) 516-8188 for an appointment to talk about your business.

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