Payers’ workers comp drug spend declines: survey

Opioid prescriptions remain a top concern

Workers Comp

By Allie Sanchez

Payers’ pharmacy spend went down by almost 9% in 2015, according to the latest survey by pharmacy benefit managers’ (PBM) consortium CompPharma.  

The 13th Annual Survey of Prescription Drug Management in Workers’ Compensation examined the 2015 pharmacy cost data of 30 workers’ compensation carriers, third-party administrators, self-insured employers, and state funds.

According to the study, payers credit more stringent clinical management, improved integration with PBMs and prescriber interventions for the downtrend. All the respondents had opioid management programs in place to minimize initial opioid prescriptions and decrease morphine equivalents in as many claims as possible, where it is appropriate.

 “Twenty percent of the respondents also had assertive settlement initiatives and have been closing older claims,” Joseph Paduda, CompPharma president told reporters. “Overall, payers have seen drug costs go down by 11% in the past six years despite the 2014 increase.”

Of all the prescriptions, opioids remain the top payer concern, while compounds ranked as the main emerging issue.

Meanwhile, PBM consolidations got mixed responses from the payer community. A number of respondents said they hope mergers would improve pricing and result in better clinical capabilities. However, others were concerned that the subsequent lack of competition would result in complacency.

“There is a sense of acceptance along with a little wariness about potential customer service issues. Consolidation in other segments of the industry has spawned customer service problems when people-based operating models were replaced with offshored or tech-enabled models,” Paduda concluded.

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