Medication trends shaping workers' compensation

A 2017 mid-year review of the prevailing industry influences affecting pharmacy outcomes

Analysis of our data, the industry’s largest workers’ compensation pharmacy data set, for the first seven months of 2017, indicates pharmacy cost and utilization continue to decline. This decline more than offsets the rate of average wholesale price (AWP) inflation. And while opioid analgesics remain the most frequently prescribed therapeutic class in terms of both the percentage of total spend and the total number of prescriptions dispensed, the percentage has now dropped below 30 percent. Steep declines in the cost and use of compounded medications are also noted. The use of generic medications continues to increase while the cost and use of specialty medications remain steady.

Mid-year 2017 overall cost and utilization trends

Our programs delivered a decrease in the average prescription cost per claim of 5.1 percent, evidenced by a 3.4 percent decline in utilization along with a 7.0 percent reduction in product and claim mix. This more than offsets growth in AWP inflation of 5.3 percent.

Overall Cost and Trends

Persistent downward trajectory in opioid analgesic utilization

A bi-product of our well-established, comprehensive medication management programs working in conjunction with stakeholders throughout the system, and in an ever-evolving regulatory and legislative environment, is the continuing decline of all metrics associated with opioid analgesics.

Opioid Analgesic

​Sustained declines in the cost and use of compounded medications

Deploying clinical tools and expertise to confirm documented medical necessity of compounded medications continues to help improve the safety, efficacy, and cost-effectiveness of care. As with all high-cost medications, payers are encouraged to remain diligent in efforts to make certain the prescribed medication is the right medication at the right time.

Compounded Medication

Generic utilization continues to rise

Analysis shows the use of generic medications continues to rise, and today stands at 85.6 percent. Furthermore, generic efficiency remains strong at 99.7 percent. Such persistency is indicative of comprehensive prospective plan design criteria, strong network enforcement, and effective prescription capture programs.


Utilization of specialty medications remains flat though spend declines

Consistent year-over-year results reaffirm specialty medications do not yet represent significance to our workers’ compensation book of business. The first seven months of 2017 show a 7.6 percent decrease in total spend, while the number of claimants using specialty medications as well as the percentage of total spend and total prescriptions attributed to specialty medications remains flat.

BetterCare

For questions about these results or for more information about our pharmacy care services, email expectmore@optum.com.

Click here to download a PDF of this report. 

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