I’m on a bit of a tear these days on the work comp drug thing; the more I talk with knowledgeable people the crazier it gets. Several recent conversations concerned the factors driving up costs: here’s what a few industry experts believe.
When you net it out, costs go up due to two factors – the price per pill and the number of pills. Yes, this is simplistic, but it provides a good starting point.
Price increases last year were primarly due to two factors – manufacturers taking advantage of Part D enrollment to tack on a few extra points across the board and Cephalon dramatically increasing prices for Actiq before it went off patent at the end of the year.
Both factors probably contributed 6-8 points of price inflation.
Utilization of pain meds continues to ramp up, especially for meds that are not specifically for pain. This category includes ant-convulsants and nerve pain meds.
AWP is going away soon. And good riddance.
The sooner Workers Comp payers stop thinking about the price per pill and start thinking about the cost of drugs on a per-claim basis, the better off they will be.
Joe – Found your comments intersting as I just spent time on the AmerisourceBergen web site. The company, and its subsidiary PMSI/Tmesys, touts its utilization management products that include analysis of drug use, provider profiling, formularies and other solutions. These business tools are not utilized by Work Comp carriers and TPAs primarily for two reasons – a lack of vision and knowledge that the options exist and a subsequent failure to invest in technolgy to readily access the tools!
Anyone who reads a newspaper, listens to a radio or watches TV knows that drug use continues to rise. However, the Work Comp folks just keep looking for a discount to report as “savings” instead of medically (and ethically) managing the patients whose care is under their supervision.
Joe,
Could not agree with you more. It truly is not about the discount because the numbers can be slanted to validate any argument. The focus should be on utilization. I have found that our PBM really understands that concept and has developed their Trend Management programs to align with our interest and our injured workers’ safety. Their Predictive Modeling tool helps us identify early the patients need that extra level of care and case management. Thanks for raising awareness to the real issues.