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A recent report on prescription opioid abuse in workers compensation is interesting for the light it sheds on pharmacy benefit managers and third party administrators.
The information on the narcotic pain medications contained in the report from broker Lockton Cos. L.L.C. is alone interesting enough. For example, the report states that “prescription opioids are presently the number one workers' compensation problem in terms of controlling the ultimate cost of indemnity losses.”
But the report also discusses some challenges employer face when relying on reports from their pharmacy benefit managers.
“There is usually too much fluff and not enough substance for effective employer decision making,” Lockton's report states. “Remember, managed care reports represent only those prescriptions processed through the pharmacy benefit management provider, which may only be between 50 to 60 percent of the total pharmacy spend. We have yet to see a stewardship report include a slide on “Total Estimated Losses in Net Savings through PBM Leakage.”
PBM leakage refers to prescriptions and bills that are not process by the PBM.
Lockton also reports that it has found that third party administrators “simply do not know what the employer is actually spending on pharmacy.”
Lockton's report is available here, and should provide anyone wanting to learn more about managing pharmacy costs a good place to start.