Our Medicated Society

Some occupational medicine physicians go out of their way to avoid prescribing narcotic medications, and when their use is justified, they only recommend a limited course. However, data show this is not always the case.

In a brief released this week, the National Council on Compensation Insurance sheds light on pharmacy costs based on an updated analysis of 2008 data. (Refer to Workers’ Compensation Prescription Drug Study: 2010 Update: https://www.ncci.com/documents/2010_ncci_research_rxdrug_study.pdf)

Among key findings:

1. Prescription drugs represented 18 percent of total medical costs in the study year.
2. Physician-dispensed drug costs rose dramatically in almost every state.
3. Three-fourths of workers’ compensation re-packaged drug costs originated from physicians.
4. Costs for repackaged drugs have grown out of proportion to the number of prescriptions written because of re-pricing practices.
5. Utilization has overtaken price as the leading factor affecting per-claim workers’ compensation drug cost increases.
6. Physicians often dispense more than one drug at the same time.
7. Claimants frequently continue to receive physician-dispensed drugs for extended periods. 
8. Oxycontin® led the pack in terms of costs in 2008.

Meanwhile, PMSI’s 2010 Annual Drug Trends Report features findings from a 2009 analysis of millions of retail and mail-order pharmacy transactions.  (Refer to http://www.pmsionline.com/knowledge-center). According the report, while the use of narcotic analgesics for the treatment of new work-related injuries decreased 7.8 percent, average pharmacy spend per injured worker increased by 6.5 percent.

In addition:

• Growth in total spend was attributed to increases in prescription price of 4.7 percent and net change in utilization of 1.7 percent.
• There was a 2.2 percent increase in the days of supply per prescription from 27.6 days in 2008 to 28.2 days in 2009.

These data support the use of a multi-faceted approach that includes cost management through the use of fee schedules, generic medications and appropriate formularies; utilization review and reductions in concurrent use of medications; and clinicians working with claimants to develop alternative interventions for chronic pain patients.