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Helios average workers comp prescription cost rises 3.9%

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The average cost of a workers compensation prescription increased 3.9% last year, the first increase in more than a decade, pharmacy benefit manager Helios said Thursday.

The increase, due primarily to inflation in the average wholesale price of medications (see chart), compares with a 1.7% decline in the overall average prescription price per comp claim in 2013, according to Helios' 2015 “Workers' Compensation Drug Trends Report.”





The Memphis, Tennessee-based PBM resulted from the combination of Progressive Medical Inc. and PMSI Inc.

The average wholesale price for generic drugs increased 10% in 2014, up from 0.7% in 2013, according to the analysis. Meanwhile, the rate of inflation in brand-name drug prices eased to 12.5% in 2014 vs. 13.3% in 2013. As a result, the overall weighted average wholesale price increased 11.4% in 2014.

“Despite the high rate of (average wholesale price) inflation, the use of generic medications continues to be an effective means of controlling cost,” according to the report, which said generics accounted for 79% of more than 7 million prescriptions in 400,000 claims analyzed for the report. “Higher utilization of generic medications yielded greater savings for the payer without detriment to the injured worker.”

Last year also saw a 4.4% decline in utilization, which Helios attributes to “claim management, highly targeted utilization review and clinical programs.”

The rise in average wholesale price and the decline in utilization, among other factors, resulted in a 3.9% increase in the average prescription cost per claim — the first increase in more than a decade, the report states.

The report also found the number of injured workers using opioids decreased 1.6 percentage points to 60.2% in 2014, showing that Helios' “aggressive formulary management, clinical interactions and early intervention programs were effective.”

Compounded medications are another big concern for workers comp payers, as the drugs are expensive and often are used inappropriately as a first-line therapy without evidence of efficacy, according to the report. Such drugs represented 5.6% of total spending and less than 1% of total prescriptions in Helios' book of business last year.

The cost of specialty medications represented 0.2% of total prescriptions dispensed and increased 26.5% last year. The increase resulted primarily from relatively new medications to treat hepatitis C and the increased use of medications to treat HIV.