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Managing the pain of prescription drug costs: Defining the scope


Prescription drug costs are becoming an increasing percentage of total workers’ compensation costs.  Today, medication prices are rising faster than any other medical expenditure.  Further, the expanded use of powerful narcotics and opioids is fueling these expenditures as they are becoming more commonly prescribed in response to work-related injuries.  And, these powerful drugs are not only expensive but can have a noticeable impact on productivity when misuse or abuse occurs.

Successful employers today are fighting back.  Many have put together multi-faceted, clinically based narcotic and drug management programs that are producing reduced costs and increased performance.   At the same time, these programs often result in increased quality of life for injured workers.

Defining the scope of the problem

The increasing use of narcotics and opioids to treat workers’ compensation injuries is a driving factor behind rising costs.  Per-claim narcotic costs have increased more than 50% over the past decade.  While narcotic use is concentrated among a small percentage of claimants, it now represents more than $1.4 billion of total drug spend in workers’ compensation claims.

Many of these medications, however, were not originally intended to treat occupational injuries.  While they have been shown to relieve pain, there is little evidence to support the benefit of their long-term or widespread use in the workers’ compensation arena.  Furthermore, there is a high risk for abuse, dependency and overutilization with many narcotics and related drugs.

Strategies and solutions

Despite the scope of the problem and its related challenges, many employers are making headway in reining in these rampant costs.  Among today’s more progressive solutions and strategies are:  well-designed formularies, authorization alerts, case history reviews, close narcotic monitoring, follow up appointments, employee education, pharmacy clinical reviews, a strong network of pharmacies and prescribing providers, and technology.  The effective integration of these strategies and techniques can result in a complete and comprehensive narcotic and drug management program.

For additional information, read part two of this post, where we dig into these strategies and solutions in a more detailed way and show how the different components of an effective drug management program can make an impact in not only utilization and costs, but ultimately the injured worker’s well-being and return-to-work progress.

Kimberly George, SVP, Managed Care Practices and Client Services

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