Articles | Cases

Just what the doctor ordered: how you can control Workers' Comp prescription drug costs

At NCCI's Annual Issues Symposium in Orlando, FL, new statistics about prescription drugs in Workers' Compensation were unveiled. The findings were unsettling, but not surprising.

While the overall share of prescription drugs, as a percentage of medical costs in Workers' Comp, has held steady at around 18%, the drugs that are being prescribed and how they are being fulfilled are of major concern.

The first is the rising trend of physicians dispensing their own drugs. When physicians dispense, they sometimes compound drugs, leading to prescriptions that can be billed without a fee schedule and they can also charge a dispensing fee, leading to even higher costs. According to NCCI, around $50 of the $265 of prescription costs per claim can be attributed directly to physician dispensing.

The other troubling statistic is the number of narcotics being prescribed. The cost per claim for narcotics is up from $39 in 2003 to $59 in 2011. This equates to a rate of .79 narcotic prescriptions per claim, up from .56 in 2003. Of these narcotics, OxyContin is the most troubling. Statistics reveal that 25.5% of all money spent on narcotics is spent on OxyContin.

According to OxyContin is used to treat moderate to severe pain expected to last for an extended period of time. Yet, it's addictive and "prescription diversion" (sold on the street) potential are well known and often lead to abuse.

The statistics seem to bear out this concern. It turns out that 5.6% of all Workers' Comp claims that resulted in at least one prescription for any medication had included five or more prescriptions for narcotics. About 20% of claims had just one prescription for narcotics, and less than 2% got four prescriptions for narcotics.

Knowing all of this, how can you control these costs in your business? It all starts with the doctor that is treating your injured employee. In most states, employers have the ability to direct injured employees to a doctor of the employer's choice. The rules about how this can be done vary from state, so it's critical that you discuss the exact process with your insurance agent.

Once you determine that you have the right to direct care, you have to find the right doctor. Start by searching for a doctor in your area who is board certified in Occupational Medicine. You can search If you can't find one, search your area for physicians that market services for Workers' Compensation. Many urgent care clinics make great partners. Once you find a doctor, talk to them about your business. Discuss your return to work program and the types of transitional work you have available. And talk to them about their attitude on prescribing narcotics.

Once you have selected the doctor, then it becomes a matter of consistently directing your injured employees to this physician. The doctor will treat the injured employees quickly and send them back to you with restrictions that you can accommodate by assigning transitional duty while they recover.

What if you can't direct care? In most states, even if you can't require an injured employee to see the doctor of your choice, you can still suggest that they go to a particular doctor. Saying "Doctor Bob and ABC Urgent Care has treated many of your co-workers and they've gotten better quickly" can help encourage an employee to see the physician of your choice.

Choosing the right doctor, one who doesn't dispense drugs in their clinic and who only prescribes narcotics when they are absolutely necessary, can go a long way to helping your injured employees get back to work quickly and be happy, healthy and productive as swiftly as possible.

When you have a doctor that works with you to get your employees back to work, you have one of the most powerful tools to control your Workers' Compensation costs.

This article was adopted from an article by Kevin Ring, Director of Community Growth for the Institute of WorkComp Professionals of which we are a member.