The report is based off of information from bills that went through bill review as well as their Pharmacy Benefit Management program, First Script.
Specialty drugs are not utilized widely in workers’ comp, just 1.1 percent, but they do make up just about 5 percent of overall prescription costs. The report found that the aggregate utilization of specialty medications actually rose last year by .1 percent and costs rose as well, increasing from 3.8 percent to 4.9 percent between 2015 and 2016.
In the managed care world, utilization of specialty medications rose by 19.4 percent in scripts per claim and they saw a 7.9 percent increase in cost. Hepatitis medications saw a 54 percent decrease but medications for blood clotting and HIV/AIDS accounted for 74 percent of the utilization increase last year. The authors of the report saw that the decrease in medications could have mitigated the cost impact of such an increase for blood clothing and HIV/AIDS medications.
Unmanaged care saw an increase of 3.4 percent in scripts per claim but a 29.5 percent increase in cost. The report names the anemia medication Aranesp as largely responsible for this increase in cost per claim. As a total percentage of prescriptions, specialty drug utilization was reported as 0.65 percent for managed populations and 2.53 percent for unmanaged, almost four times as high as the managed population.
The report also looked at closed formularies. Last year Nebraska, Montana and New York adopted a closed formulary to make 14 states with such regulations. Illinois, Pennsylvania and Louisiana proposed to adopt a closed formulary.
Read the report here.