Between treatment, rehabilitation and medication costs, recovering from a workplace injury can become very expensive very quickly. In particular, the expense associated with certain prescription drugs cost the workers' compensation system billions of dollars in wasted pharmacy-related funds last year, according to the 2011 Express Scripts Workers' Compensation Drug Trend Report.
The report indicates that the use of expensive medication (instead of lower-costing, therapeutically equivalent drugs) accounted for approximately $2.1 billion in wasted funds. In addition, the workers' comp industry saw $107 million wasted due to the use of out-of-network pharmacies and third party billing; and $40 million wasted through the use of "higher-cost" delivery channels (like retail pharmacies) for long-term medication.
• 76.2% of total drug spending in 2011 was associated with the top six "therapy classes," which include narcotic analgesics, anticonvulsants, anti-inflammatory drugs, and dermatological medication.
• Narcotic analgesics have the highest annual cost per user ($508). This therapy class also accounts for approximately 38% of total drug spending and 34% of total utilization.
• 10% of total drug spending in 2011 was associated with the powerful painkiller Oxycontin. This drug also had the highest cost per user.
• The biggest spike in costs was associated with dermatological medication, which rose 7.4% in 2011.
According to Express Scripts' official press release,
"Behaviors such as habit or lack of awareness can lead some physicians to continue to choose branded medications over more clinically equivalent, lower-cost generic alternatives. Injured workers may also request the more expensive medication. These behaviors drive up the cost of the workers' compensation pharmacy benefit."
The report also indicates that about 125 million U.S. employees are currently eligible for workers' compensation coverage. Approximately 4.2 million of these employees suffer work-related injuries and illnesses every year.
Tim Pokorney, pharmacist and clinical director of workers' compensation at Express Scripts, maintains that the entire system can improve with greater awareness of these issues. "By applying clinical evidence and behavioral science insights to workers' compensation, we can save billions of dollars and improve health outcomes," Pokorney said. "It is critical for employers and payers to get a handle on the costs associated with workers' compensation prescriptions, and we have the solutions to help them to do so, leading to better outcomes for injured workers with minimal disruption."
The rising costs associated with prescription medications have created problems in workers' compensation programs throughout the country. For example, Kentucky's state Legislature is currently considering a new law designed to curb these costs and their resulting strain on the workers' compensation system. In particular, the law focuses on pain medicines like Oxycontin: Kentucky statistics show that these drugs are being prescribed more frequently, and since they have a high rate of addiction and abuse, more employees are either returning to work impaired or failing to return to work at all.
"The proliferation of prescription drugs cost employers through higher health insurance and workers' compensation costs," reports SurfKY.com. "Prescription cost increases are currently the largest cost driver in Kentucky's workers' compensation system. Trends suggest drugs are given out at a much faster pace, rather than utilizing other rehabilitation methods to help heal injuries and allow employees to return to work."