Narcotic drugs persist as key Workers' Comp driver

Last month two major pharmacy benefit managers (PBM), Express Scripts and Progressive Medical, Inc., released studies showing that narcotics, anticonvulsants, anti-inflammatory medications and antidepressants remain among the most commonly prescribed drugs for Workers' Compensation claimants. With costs of drugs representing 19% of total Workers' Comp medical expenses (NCCI Holding, Inc.), little evidence that long-term opioid use is appropriate for Workers' Comp injuries, and the associated risk of addiction, this is a treacherous trend leading to longer claim duration and higher costs.

Although both PBM's reported a reduction in utilization of narcotics (4.2% and 3.9%), the narcotic drug category was the largest, representing 35 to 40% of Workers' Compensation drug spending. It was noted that early intervention in the life of the claim is needed not only to lower costs but also to keep workers' safe.

Cognitive behavioral therapy gaining acceptance for claimants who suffer from chronic pain and psychosocial issues

Two recent Business Insurance articles, "Worker's comp payers backing cognitive behavioral therapy" and "Faster return to work times, lower costs" point out that some prominent Workers' Compensation payers are actively recommending cognitive behavioral therapy (CBT) for claimants who suffer from chronic pain and psychosocial issues that are hindering their recovery. CBT is based on the idea that people's thoughts and perceptions, rather than external factors, drive their attitudes and behaviors. It can help claimants address their perceptions of pain, negative views of the workplace or other factors that hinder their motivation to return to work.

Dr. Jacob Lazarovic, chief medical officer at third-party administrator Broadspire Services Inc. in Sunrise, Fla., was quoted, "The data is pretty impressive that a lot of these folks with chronic pain don't do better-and, in fact, do worse-when they are treated conventionally with opioid medications and with spinal fusions and aggressive interventions," Dr. Lazarovic said. However, injured workers "do much better when you are addressing the psychosocial aspects of their condition and using a tool like CBT."

Unnecessary use of higher priced medications lead to nearly $2.1 billion in wasted spending

For the first time the Scripts Express report identifies various areas of waste and quantifies potential savings. The company's research found:

• $2 billion of waste resulting from use of higher-cost medications when therapeutically equivalent, lower-cost alternatives are available.
• $107 million of waste through use of out-of-network pharmacies and third-party billing.
• $40 million of waste from use of higher-cost delivery channels, such as retail pharmacies instead of home delivery for long-term medications used by injured workers.

There is little doubt that Workers' Compensation pharmacy costs are higher than they should be. Employers can do their part by partnering with the right medical providers, understanding effective alternative treatments, closely monitoring prescription costs and educating employees about the personal risks and work-related hazards of misusing and abusing prescription drug.