By Phil Walls, RPh, Chief Clinical Officer, myMatrixx
myMatrixx released our 2019 Drug Trend Report on July 8, and with it we’re sharing important data-driven insights with the industry at large.
As an Express Scripts Company, myMatrixx represents the workers’ compensation division of a large PBM, serving 100 million people. This gives us a tremendous set of data metrics and analytics that we can provide to clients on critical drug trends.
Of particular interest is the year-over-year percent change in prescription drug spending for injured workers, including specialty drugs paid under the pharmacy benefit. We’re proud to produce this report in conjunction with the Express Scripts Lab, which has unsurpassed clinical innovation and insights.
Each year, myMatrixx’s Drug Trend Report offers a wealth of key facts and figures for policy-makers, decision-makers, analysts and frontline adjusters across the workers’ comp sector to absorb. You’ll see in our 2019 report that we have many positive stories to share.
What Key Themes Did We Uncover From 2019?
First, even though rising drug costs continued to grab attention last year, myMatrixx once again delivered a decrease in drug spending to payers. In fact, overall spending on drugs declined by 6.1% when compared to 2018, and total medication dispensed decreased by 4.3%.
While significant progress has been made in decreasing opioid utilization, it should continue to be an area of concern in workers’ comp pharmacy, and we’re glad to report a 10.7% decline in opioid spending last year. In fact, 73.1% of payers spent less on opioids in 2019 versus 2018, part of a five-year consecutive decline in spending.
That is a fantastic win for everyone and results from multiple strategies that include the myMatrixx myRxAdvocate pharmacovigilance program, government initiatives and concentrated provider awareness and education. Recognizing the difference in the impact on new injuries versus older claims has led to targeted clinical pharmacy interventions from myMatrixx that yield the greatest impact for each injured patient regardless of their date of injury. This means many of our clients are now experiencing no opioid utilization for new claims. Through this highly focused strategy, our pharmacists are literally saving patient lives every day; and we are excited to share our success with you!
Yet another way we accomplished reduced spending for payers is by closely measuring the efficiency and utilization of generic drugs. One of our biggest success stories was an aggressive generic substitution campaign in the wake of the expiration of the Lyrica® patent last July. We’re proud to report that these efforts resulted in 91.8% of all Lyrica prescriptions converted to generic equivalent pregabalin within four weeks and 96.4% within 180 days of expiration of the patent.
Watch Out For These Emerging Trends
Our clinical team also uncovered a number of emerging trends which will drive the industry and warrant increased awareness. While myMatrixx has all but eradicated pharmacist prepared compounds as an issue that payers face, we’re gaining a greater understanding of an emerging threat known as private-label topicals. This a subcategory of topical drugs which can represent egregious drug pricing with little or no added clinical benefit. These private-label products are the newest concern to evolve from physician dispensing and have moved the dial from hundreds to thousands of dollars in excessive costs. However, we have already developed a client-specific solution, aligned with unique jurisdictional guidelines, which has led to proven results for a wide range of clients.
Another significant area of concern we’ve identified in the report and will continue to explore is the growth of “super-spending.” Super-spending can be defined as annual drug expenditures in excess of $250,000 for a single patient. This term originated in the commercial market, but we’re starting to see it in workers’ comp as well. At myMatrixx, we’ve been able to identify a number of claims in our database that exceed $250,000. We’ve even found one claim with drug costs in excess of one million dollars a year, a figure which can be seriously disruptive to any business’s bottom line. The good news: patents are starting to expire on specialty drugs as well, and in the above case, we were able to generate more than $400,000 a year in savings through generic substitution of a specialty drug.
Finally, the workers’ comp industry is also dealing with the healthcare needs of an aging workforce. Traditionally, the workers’ comp system has seen a high percentage of middle-aged employees. However, we’ve identified that 35% of injured workers in our database are age 55 years or older. Certain drugs, such as opioids, should be prescribed to senior patients only with caution, if at all, while alternatives to opioids like NSAIDs can cause cardiovascular complications. There are several solutions for this that myMatrixx has implemented, particularly, better management of these cases at both the point of prescribing and dispensing.
For the full story, we invite you to download and review this important and comprehensive report.
To gain access to additional workers compensation trends and detailed data insights, download the full myMatrixx Drug Trend Report now.
This is a sponsored post from WorkCompWire marketing partner myMatrixx.