Prescriptions drug costs account for just 7 percent of medical costs in workers’ compensation according to NCCI.
The National Council on Compensation Insurance (NCCI) released its latest installment on inflation in workers’ compensation covering prescription drugs. Findings show that from 2012 to 2021, the average drugs-paid cost per claim decreased by 2.6 percent annually. Prescription drug prices in workers’ compensation grew at an annual rate of 3.7 percent on average during the 9-year study period. However, this average is offset by a 6 percent decline in prescription volume. Of all drug classes, opioid claims saw the most significant drop in drug costs. Of all claims with prescriptions, the share of those that included at least one opioid decreased from 55 percent in 2012 to 26 percent in 2021. On a nationwide basis, drug costs comprised only 7 percent of workers’ compensation medical costs, with a sharp reduction in payments observed since 2016. While all regions of the country experienced drops in drug expenditures, the Southeast saw the slowest decline at an annual drug average change of -2 percent.
WCRI researchers claim that orthopedic surgeons see the highest number of workers’ compensation patients among any other provider types.
A newly released study from the Workers’ Compensation Research Institute (WCRI) claims that the average orthopedic surgeon sees the largest number of workers with injuries compared to other provider types. Orthopedic surgeons see three times as many injured workers as primary care physicians over the same period, according to data collected from 34 states between 2016 and 2018. Researchers discovered that most primary care physicians have minimal exposure to workers with injuries, as more than half saw just one to three workers’ compensation patients over three years. Only 7 percent of primary care doctors saw over 50 workers’ compensation patients over a three-year timetable. Other providers with frequent interactions with workers’ compensation medical treatment include radiologists, those based in physical medicine, and pain management physicians.
Proposed bill language in the Senate aims to assist patients with chronic pain receive appropriate treatment.
SB23-144 is poised for a floor vote in the House after favorable committee hearings. Bill language aims to assist patients with chronic pain in receiving appropriate treatment. Specifically, the bill clarifies that a healthcare provider is not subject to disciplinary action for prescribing a dosage that is equal to or more than a morphine milligram equivalent dosage recommendation or threshold specified in state or federal opioid prescribing guidelines. Furthermore, SB23-244 prohibits a provider from refusing to accept or to continue to treat a patient solely based on the dosage of a drug a patient requires for the treatment of chronic pain. Pharmacists, health insurance carriers, or PBMs refusing to fill or approve coverage for a drug due to a patient's dosage needs is also prohibited. If approved by the House, the bill would become effective immediately with the Governor’s signature. The Senate approved the proposed legislation earlier this month.
A Senate committee voted in favor of legislation that would provide Pharmacy Benefit Managers (PBM) with a state public records exemption.
The state legislature is taking its first steps to provide Pharmacy Benefit Managers with a public records exemption. SB1552 received approval from the Health Policy Committee by a 12-0 vote earlier this week. The legislation will now go before another Senate committee for further review. If passed, the bill would be in effect with the Governor’s signature.
New research indicates that the state’s formulary held little impact on prescribing practices.
Findings from the Workers’ Compensation Research Institute (WCRI) show that the state formulary’s impact on prescribing practices were minimal based on data for prescriptions filled between January 1, 2016, to March 31, 2021. Researchers believe that the minimal impact is likely due to the vast majority of medications dispensed to injured workers being for “Y” drugs that are deemed safe and effective for workplace injuries. The share of prescriptions for preferred “Y” drugs comprised 89-91 percent before and after the formulary came into effect.
A review of the state formulary shows that New York’s state specific protocols likely led to a 34 percent prescription payment per medical claim decline from Q3 of 2019 to Q1 of 2021.
WCRI’s latest state data indicates a clear impact from New York's formulary implementation. Prescription payments per medical claim decreased by 34 percent from Q3 of 2019 to Q1 of 2021. Following the application of the drug formulary, the number of prescriptions for non-formulary drugs per claim with medications dropped by 39 percent, a number that suggests that many prescribers in the state may have opted for a switch to formulary drugs without quantity limits and that are not subject to prior authorization protocols.
Regulators revise the Workers’ Compensation Division’s (WCD) pharmaceutical justification form.
After initialing scrapping its pharmaceutical justification form earlier this month, the Workers’ Compensation Division (WCD) revised its decision. The agency says the justification form does not have to be completed if a drug on the list is prescribed on or after April 1, 2023. For prescriptions on the list written before April 1, 2023, physicians and other providers must complete a clinical justification form when prescribing more than a five-day supply of certain high-cost drugs.
Division of Workers’ Compensation (DWC) personnel have announced a formal review of the first seventeen chapters of title 28 statutes.
The Division of Workers’ Compensation (DWC) plans to review several rules in the first 17 chapters of Title 28, which includes Chapter 42, Medical Benefits. DWC officials hope to eliminate unnecessary/outdated provisions while also considering potential amendments to existing rules. Division personnel will allow for public comments until May 1 at 5 PM CST “on whether the reasons for initially adopting these rules continue to exist, and whether these rules should be repealed, readopted, or readopted with amendments.”
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