Cost Increases Drive Higher Drug Trend for Workers' Compensation

       Cost Increases Drive Higher Drug Trend for Workers' Compensation

Spending on Compounded Medications More Than Doubled in 2013

PR Newswire

ST. LOUIS, April 10, 2014

ST. LOUIS, April 10, 2014 /PRNewswire/ --Significant increases in cost per
prescription drove drug trend for workers' compensation payers higher in 2013,
according to research released this week by Express Scripts (NASDAQ: ESRX).
Overall pharmacy spending for workers' compensation increased 9.5 percent,
according to the Express Scripts Workers' Compensation Drug Trend Report,
primarily from an 8.2 percent jump in cost per prescription. Effective
management programs helped keep utilization increases to just over 1 percent.

Express Scripts, St. Louis, Missouri. (PRNewsFoto/Express Scripts)

Drug trend — defined as the annual rate of increase in pharmacy spending — is
the combined effect of changing drug prices and utilization.

The Increasing Challenge of Compounded Medications

Compounded medications used for injured workers saw the most significant
increase, with per-user-per-year costs rising 126 percent from 2012. Although
these medications account for just 2.7 percent of total pharmacy costs in
workers' compensation, the dramatic rise in price impacted overall trend.

Compounded medications are tailored drugs prepared by mixing, combining or
altering ingredients. While intended to address special pharmaceutical needs
of some injured workers, compounds tend to be significantly more expensive
than commercial formulations. In many cases, there are Food and Drug
Administration-approved alternatives for compounded medications. Compounded
medications can also pose safety issues.

"Without consistent protocols to prepare each drug, compounded drugs can have
a greater batch-to-batch variability," said Tim Pokorney, senior vice
president, clinical services for workers' compensation at Express Scripts.
"This raises significant safety concerns as injured workers could be receiving
medication with a higher potency than intended."

Express Scripts helps payers effectively manage the rising costs of compounded
medications and ensures safe treatment for injured workers. At the point of
sale, clients have the option of reviewing all compounds for authorization.
Retrospectively, Express Scripts sends letters to physicians encouraging the
use of commercially available, cost-effective alternatives where appropriate.
Our research has shown that 42.3 percent of injured workers whose physicians
received such communications from Express Scripts discontinued filling
compounded medications, thus helping drive down costs for payers.

Narcotics Remain Costliest Therapy Class

Higher prices in other therapy classes also contributed to the growing trend.
Key findings of the Workers' Compensation Drug Trend Report include:

  oNarcotic analgesics continue to be the costliest therapy class for
    work-related injuries, accounting for 32 percent of overall pharmacy
    costs. While utilization has declined for the third straight year, costs
    continue to rise.
  oCost per prescription for hydrocodone-acetaminophen, a long-standing
    generic, increased 7.2 percent — twice the increase in 2012.
  oNon-steroidal anti-inflammatory drugs — or NSAIDs — which are non-narcotic
    medications used to address various pains and conditions, saw a 19.4
    percent increase in cost.
  oSpecialty medications, including those to prevent blood clots following a
    surgery, osteoarthritis and inflammatory conditions, make up only 1
    percent of overall pharmacy spend in workers' compensation but pose a
    growing cost challenge for payers. The average cost per prescription of a
    specialty medication was more than $1,119 in 2013 — nearly nine times that
    of the average traditional medication.

The Express Scripts 2013 Workers' Compensation Drug Trend Report is available

Printed copies also will be available at the Risk Management Society (RIMS)
Conference, April 27-30 in Denver, in booth #220.

About Express Scripts

Express Scripts (NASDAQ: ESRX) manages more than a billion prescriptions each
year for tens of millions of patients. On behalf of our clients — employers,
health plans, unions and government health programs — we make the use of
prescription drugs safer and more affordable. Express Scripts uniquely
combines three capabilities — behavioral sciences, clinical specialization and
actionable data — to create Health Decision Science^SM, our innovative
approach to help individuals make the best drug choices, pharmacy choices and
health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated
pharmacy-benefit management services, including network-pharmacy claims
processing, home delivery, specialty benefit management, benefit-design
consultation, drug-utilization review, formulary management, and medical and
drug data analysis services. The company also distributes a full range of
biopharmaceutical products and provides extensive cost-management and
patient-care services.

For more information, visit or follow @ExpressScripts
on Twitter.

Riddhi Trivedi-St. Clair
Office: 314-684-6665

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SOURCE Express Scripts

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