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Mail order pharmacy savings rarely tapped in workers comp

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Few workers compensation prescriptions are filled via mail order despite lower prices for payers and increased compliance by injured workers, experts say.

The workers comp industry hasn’t fully embraced mail order pharmacy, said Joseph Paduda, president of Madison, Connecticut-based CompPharma L.L.C., a consortium of pharmacy benefit managers.

Mail order penetration has been “up and down over the last seven years,” though it typically hovers around 5%, according to CompPharma’s latest Prescription Drug Management in Workers Compensation survey, released Tuesday.

The 21 large workers comp payers in the survey, which are insurers and self-insured employers, reported that 4.7% of prescriptions were filled via mail order last year, down from 5.0% in 2013 (see chart).


“Payers have downsized their medical management staff, and they don’t have the people to focus on (mail order),” Mr. Paduda said. The “industry is missing a major opportunity” by not taking better advantage of mail order pharmacy, which is more prevalent in group health plans, he said.

On the group health side, mail order is utilized often by patients who take maintenance medications for chronic conditions such as hypertension. For injured workers, it depends on the injury type and the stage of the claim, experts said.

For example, injured workers living in rural areas or who have catastrophic injuries might find mail order to be more convenient, said Bill Erwin, Memphis-based vice president of business operations at PBM Helios.

“Mail order pharmacy is an important tool and there are places where it’s both effective and efficient, but it needs to be something that works for the carrier and the injured worker,” said Mark Sektnan, Sacramento, California-based vice president at the Property Casualty Insurers Association of America. “It’s used more on long-term maintenance medications, particularly for injured workers who may be receiving benefits out of state.”

Unlike group health, there’s no financial incentive for injured workers to use mail order since they do not pay for their medications, Mr. Erwin said.

In addition, some prefer the social interaction involved with visiting a retail pharmacy, experts said.

However, there is a financial incentive for payers, experts said, noting that drugs are less expensive when they’re dispensed in a 90-day supply via mail order than monthly at a retail pharmacy.

According to Helios’ 2015 Workers’ Compensation Drug Trends report, the average cost per day for a mail order prescription was $4.92, 19.8% less than the retail equivalent of $6.14.

Other benefits of using mail order in workers comp include increased medication adherence among injured workers since prescriptions are delivered directly to them, and there are no transportation costs associated with trips to the pharmacy, Mr. Paduda said.

While a “significant majority” of Helios’ payer clients offer mail order in some capacity, far more prescriptions are filled at retail, Mr. Erwin said.

Payers assume they have more control when injured workers receive medications on a monthly basis, but “that’s not the reality,” Mr. Erwin said, adding that the same level of control applies to 90-day fills.