Prescription Drugs Driving Workers' Comp Hikes

Prescription drug use is one of the key factors in escalating workers' compensation expenses, accounting for nearly half the rise in costs, claims one expert.

Prescription drug use is one of the key factors in escalating workers'' compensation expenses, accounting for nearly half the rise in costs, said Ken Martino, senior vice president of Specialty Risk Services (SRS), a third-party administrator. Martino spoke at the 40th Annual Risk and Insurance Management Society (RIMS) conference held recently in New Orleans.

Martino said that a review of prescription medicine costs for The Hartford''s workers'' compensation claims clients shows that those costs have risen almost 67 percent over the past two years. Those costs can be mitigated, he added, and offered these suggestions:

  • Analyze data to understand trends and improve outcomes.
  • Provide information about options. Inform injured workers and physicians about prescription drug alternatives and implement a pharmacy benefit management program. The Hartford contracted with a pharmacy benefits management program that offers its workers'' compensation customers access to more than 90 percent of the nation''s retail pharmacies.
  • Institute a pharmacy management program. Besides saving workers'' compensation clients money through retail pharmacy discounts and generic drug substitution when appropriate and permissible, a pharmacy management program can flag potential side effects or other dangers and bring these to the attention of the pharmacist or care providers. A pharmacy benefits management program also can uncover unusual usage patterns that may indicate fraud.
  • Fight prescription fraud and abuse. The Hartford compiled data over several years on drug prescriptions, health indications and duration of drug use. This analysis uncovered the trend toward prescribing higher priced drugs for conditions successfully treated by other medications.

Other potential solutions include introduction of new state legislation to increase generic drug use and implementation of more utilization controls, said Martino. And sometimes prescription regiments are more effective when coupled with other treatment modalities such as physical therapy.

"Our goal is to help injured workers recover quickly and safely and to get them back to work without creating any new problems," said Martino.

by Sandy Smith ([email protected])

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