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Spike in use of compounded medications leads workers comp cost increases

Spike in use of compounded medications leads workers comp cost increases

The utilization and cost of compounded medications in workers compensation claims spiked last year, while the costs of antidepressants and non-narcotic painkillers also continued to rise, according to a report released Thursday by pharmacy benefit manager Express Scripts Inc.

The use of compounded medications, which include oral and topical medications that are combined or mixed, increased 71.9% from 2012 to 2013, according to Express Scripts' “Workers Compensation Drug Trend Report.” Meanwhile, the average cost per compounded medication prescription was $1,299.13 in 2013, up 29.8% from the previous year.

Compounded medications typically are used to treat neuropathic or osteoarthritis-related pain. Express Scripts said 2013 marked the first year that compounded medications were among the top 10 therapy classes used for workers comp.

Such medications have limited oversight from the U.S. Food and Drug Administration and often do not have standardized dosages or preparation, St. Louis-based Express Scripts said.

“While intended to address special pharmaceutical needs of some injured workers, compounds tend to be significantly more expensive than commercial formulations,” Express Scripts said in a statement. “In many cases, there are Food and Drug Administration-approved alternatives for compounded medications.”

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, saw a 19.4% increase in the average cost per prescription from 2012 to 2013, while the utilization of such medications grew 1.4%, Express Scripts said. Costs for that category were driven largely by a 19.1% increase in per-prescription pricing for Celebrex, an arthritis medication.

Antidepressant utilization in workers comp claims rose 3.8% last year, while the average cost per prescription of such medicines increased 10.6%, according to the report. In particular, Cymbalta had a 7.4% increase in utilization and a 19.1% increase in per-prescription cost, the report said.

The report is available here.