Express Scripts: Work Comp Drug Spend Down 7.6% in 2016

Wednesday, April 5, 2017 | 0

Workers’ compensation drug spending fell 7.6% last year, driven in part by an 11% decrease in opioid prescriptions per patient, according to a report released Tuesday by pharmacy benefit manager Express Scripts.

The decrease in pharmacy spending follows a 2.2% increase in 2015 that Express Scripts reported last year. The uptick that year was the result of a 2.6% decrease in drug utilization offset by a 4.4% increase in cost per prescription.

But for opioids, the most prescribed class of drugs in workers’ comp, spending fell for the sixth year, including a 13.4% decrease last year, Express Scripts said. The company attributed the trend to its “clinical solutions, aggressive client management, and state and federal opioid regulatory trends.”

In 2016, opioids remained the most expensive therapy class, costing on average $391 per user per year in the Express Scripts report. Thirteen of the top 25 workers’ compensation medications were opioids.

But the No. 1 drug prescribed to injured workers last year was Lyrica, the brand name for anti-seizure medication pregabalin, which is used to treat neuropathic pain. The cost per Lyrica prescription increased 14.7%, while utilization dropped 4.8%, for a 9.2% increase in spending. The cost per user per year was $102.56.

Court Orsborn, president and company officer at Donn & Co. in San Francisco, a workers’ comp managed care advisory and research firm, said workers’ comp pharmacy spending has benefitted in recent years from patent expiration of three brand drugs: Cymbalta, Lidoderm and Celebrex.

The impact of those patent expirations was seen starting in 2014 and 2015, he said, as more generic forms of the drugs have been prescribed.

“These were all top 10 workers’ comp drugs by spend ... and those collective expirations were one of the main drivers of lower prescription costs across workers’ comp,” Orsborn said. “But the impact of the patent cliff for workers’ comp has slowed.”

The next patent expiration that will have a major impact for workers’ comp is Lyrica, which is expected in 2018, he said.

The Express Scripts data is consistent with that reported by others, including CompPharma, a consortium of workers’ compensation pharmacy benefit managers.

A CompPharma report issued last year noted an 8.7% decrease in drug spending in 2015, and an 11% decrease over four years. The report was based on a survey of 30 workers’ comp payers.

CompPharma President Joseph Paduda said that while the Express Scripts report includes some positive trends regarding opioids, it’s still troubling that 51% of injured workers who received a prescription were prescribed an opioid. And 25% of injured workers used opioids for 30 days or more last year.

“That’s still way too much utilization of opioids for injured workers,” Paduda said.

The key is to tightly manage patients who are receiving a second opioid prescription, which is where many problems start, Paduda said.

The Express Scripts report also looks state-by-state at opioid prescriptions as a percentage of total prescriptions. California had the lowest number, 17.6%. Delaware came in the highest, at 39.9%.

In Texas, which is often cited as an example of a state with a successful workers’ comp drug formulary, 31.9% of prescriptions were for opioids. The numbers are for prescriptions processed by Express Scripts and may not reflect the statewide totals.

But the Express Scripts number closely matches a figure derived from data in a July 2016 report from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, “Impact of The Texas Pharmacy Closed Formulary.” Combining prescriptions of opioids that fall into an “N” or not-recommended category with opioids outside the “N” category, opioids accounted for 32% of workers’ comp prescriptions in 2013.

The “N” drugs are about 150 medications that require carrier preauthorization under the Texas workers’ comp formulary. The TDI report noted that prescriptions for “N” category opioids fell from 32,381 in 2009, before formulary implementation, to 1,022 in 2013.

A TDI spokesman declined comment on the Express Scripts report and was not able to provide more recent data for opioid prescribing on Tuesday.

According to data presented by the California Workers’ Compensation Institute at its annual meeting, opioids declined to 24% of workers’ comp prescriptions filled in the state in 2015 and 21% of the prescription drug spend, although they remained the No. 1 drug category.

It’s not yet known whether CWCI data will match the Express Scripts finding that 17.6% of workers’ comp prescriptions in California last year were for opioids.

“Whatever the extent of the recent decline, it may reflect a number of factors, including increased awareness and publicity about the risks associated with opioid use, physician education, as well as the impact of [utilization review/independent medical review],” said CWCI spokesman Bob Young.

Ninety percent of opioid prescription modifications and denials that went through IMR in 2016 were upheld, Young noted.

The Express Scripts drug trend report is available here.