Report: Workers’ Comp Claim Age Biggest Driver of Pharmacy Trends

May 10, 2012

“As a claim ages the cost of pharmacy to claim will increase over time,” said Jim Andrews, senior vice president of Healthcare Solutions’ Pharmacy Services Unit, citing results from the 2012 Workers’ Compensation Drug Trends Report.

The company’s second annual report analyzed changes in prescription drug costs and utilization patterns that occurred in developing and mature claims in 2011.

Developing claims range from date of injury up to three years of age, while mature claims are defined as greater than three years old.

The study found that some are managing workers with claims aged 15 to 20 years.

According to the report, price multiplied by utilization equals spend, the billed amount per injured worker. Two main drivers of pharmacy spend are price and utilization, Andrews said.

Price has leveled off in workers’ compensation while utilization, which is the day supply per prescription, is now considered the cost driver.

In developing claims the study found:

  • The average age of a claim was 6 months
  • The average age of the claimant was 44.4 years old
  • Generics were found to be utilized more often
  • The most significant cost increase is seen between years one and two
  • Spend per injured worker in 2011 was $520
  • Nine of the top ten utilized drugs were generic

In mature claims the study found:

  • The average age of a claim was 13.2 years
  • The average age of the claimant was 55 years old
  • Generics were found to be utilized less often
  • Average price per prescription was over $200 by year 10
  • Four out five top drugs by spend are brand name drugs: Oxycontin, Lidoderm, Lyrica, Cymbalta, gabapentin (g)
  • Spend per injured worker in 2011 was $4730
  • Significant use of antidepressants in this category

The study found that while opioids contributed the most to pharmacy spend, utilization of the drug in developing claims decreased 1.9 percent.

Anticonvulsant drug use continues to increase in both developing and mature claims, Andrews said.

Oxycontin, a problem drug in the past, has low utilization among developing claims and is decreasing in mature claims.

According to the report, increased regulatory and legislative activity has affected workers’ compensation claims. Three trends highlighted included medical treatment guidelines, repackaged and compound drugs and addressing overprescribed medications.

Andrews said the main takeaways from the study indicate that claim age is the most important driver of pharmacy trends and developing claims are significantly different than mature claims.

“There is eight times more cost in mature claims,” Andrews said, adding that preventing developing claims from getting to mature status is the best way to stem pharmacy costs.

Source: Healthcare Solutions

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