Tampa, FL – Workers’ compensation pharmacy issues barely registered on payers’ radar screens when CompPharma President Joe Paduda, also principal of Health Strategy Associates, started surveying payers about pharmacy costs in 2003.
“Back then, respondents saw costs going up, but didn’t understand why. Cost containment focused on the price per pill and the size of the retail pharmacy network,” Paduda said. “Today utilization, particularly of opioids, physician dispensing and patient safety frame the discussion, and we have witnessed a remarkable increase in sophisticated utilization management and cost-containment strategies.”
These include advanced data analytics, electronic communications, reporting, and innovative drug therapy management. The techniques seem to be paying off since the pharmacy cost inflation rate has dropped 21 percentage points during the last ten years.
“Combined with declines in new branded drugs, several popular drugs going off-patent, and effective generic conversion programs, PBMs and payers have been remarkably successful in not just managing, but actually, reducing total pharmacy costs,” he said.
For the third year in a row, opioids remain the top priority. “Payers are pushing their PBMs and internal clinical departments to analyze, intervene and take action,” Paduda said. “They have been upgrading or implementing clinical management programs with improved reporting functions and streamlined electronic processing.”
Some use relatively “soft” programs, involving letters to physicians and patient education, according to the survey. Others hired staff to deal with doctors who exhibit problematic prescribing patterns and are requiring physicians to test for drug abuse and comply with urine drug monitoring guidelines.”
In fact, all but three of the 23 respondents use urine drug testing (UDT) to monitor claimant compliance, and the other three advocate it. “UDT and monitoring was adopted faster than any other program in the history of the survey, underlining the importance of opioid management,” Paduda noted.
Click here to download a summary: CompPharma’s Tenth Annual Survey of Prescription Drug Management in Workers’ Compensation (PDF)
Source: CompPharma/King Knight Communcations