For the second year in a row, Express Scripts lowered their prescription drug spending for workers’ compensation payers. In 2016 they reduced spending by 7.6 percent per injured worker. And while opioids were still the most expensive category of drugs for workers’ compensation, with 13 of the top 25 medications, the company saw opioid prescribing continue to decline. In 2016 opioid prescription rates dropped 13.4 percent.
The company states that the reason for the decline in opioids is due to a combination of factors. Many states now have formularies or other opioid related guidelines. Payers also started to use strategies to reduce opioid use, such as prescription monitoring and patient education. The report noted that payers who started to use an MED program, which monitors morphine equivalent doses (MED) and notifies payers before a patient fills a dose that exceed MED thresholds, saw a 24.7 percent decrease in cumulative MED.
Opioids still account for a significant portion of medication prescribed to injured workers, with 50.9 percent of workers having a prescription for one in 2016. About a quarter of workers use opioids for 30 days or longer. Per user per year, opioids cost $391.35. Antidotes to opioids, such as naloxone, were increasingly utilized in 2016. They are not typically prescribed or included on formularies without payer involvement.
Compound medications declined as well, with utilization dropping by 31 percent last year. They too are not always included in formularies as they aren’t considered a “first-line” treatment for many injured worker’s cases. They are still very expensive, costing an average $1.966.92 per prescription, even though they have a very low utilization rate, at .01 compound medications prescribed per user per year.
To save payers Express Scripts also pushed for generic utilization when possible, as brand names can cost much more than an equally effective generic name drug. They also tried to deliver long-term prescriptions to workers at their home, reducing the need for more costly methods of delivery like using an out-of-network pharmacy or physician dispensing.