Controls limit workers comp drug price rise to 1.9%: Express Scripts

Utilization controls for workers compensation pharmaceutical claims have limited opioid painkiller and compounded drug usage and helped contain escalating costs for those drug categories, pharmacy benefit manager Express Scripts Inc. said.

Workers comp payers spent an average of $1,583 per injured worker for prescription drugs in 2014, up 1.9% from 2013, the St. Louis-based PBM said Tuesday in its 2014 Workers' Compensation Drug Trend Report.

A 35% increase for compounded medication prices and an 11.5% increase for opioid painkillers contributed to the 1.9% rise in claims managed by Express Scripts.

Jennifer Kaburick, the PBM's vice president of workers compensation product management and strategic initiatives, said Wednesday that cost control practices — such as utilization reviews, drug formularies and consultations with prescribing physicians — helped avoid a larger increase in overall workers comp drug spending.

For instance, opioid utilization fell 10.9% in 2014 from a year earlier, according to the Express Scripts data. While utilization increased 6.8% for compounded medications, Ms. Kaburick said that is significantly less than the 71.9% increase in compound medication utilization that Express Scripts saw in 2013 vs. 2012.

“We've got to have controls before the medication is dispensed,” Ms. Kaburick said. “But then when it is dispensed, we've got to make sure that there's outreach to both the prescribing physician and the injured worker so they understand the safety concerns and the cost impact” of narcotics, compounded medications and other costly drugs.

Memphis, Tennessee-based PBM Helios also discussed workers comp pharmaceutical costs this week in a webinar on its 2015 Workers' Compensation Drug Trends Report. The report, released earlier this month, said workers comp drug costs increased 3.9% in 2014 compared with 2013, but that utilization fell 4.4%.

A 10% increase in average wholesale prices for generic drugs contributed to an 11.4% increase in workers comp drug wholesale prices overall in 2014, Joe Anderson, director of analytical services at Helios, said during Tuesday's webinar.

It was “the highest overall increase in (average wholesale price) we've ever seen in one of our annual drug trend reports,” Mr. Anderson said.

Historically, the generic drug inflation rate has been just under 1%, Mr. Anderson said. “But this year … the generic prices shot up from that 1% level, and that's going to have big implications for the overall inflation at the business.”