Pharmacy Trends

Drug Trend Report: Costs Up, Usage Down

Despite a decrease in utilization of pharmaceuticals among injured workers, sharp price increases continue to drive costs upward.
By: | June 12, 2015

The introduction of new specialty medications, rising costs of compound medications, and an increase in the average wholesale price of oxycodone with acetaminophen are among the key drivers of pharmacy costs in the past year, according to Healthcare Solutions.

The pharmacy benefit management company is the latest to issue a drug trend report based on in-network paid pharmacy transactions in a comparison of 2014 and 2013.

“In 2014, Healthcare Solutions’ book of business saw a 4.1 percent increase in the total pharmacy spend,” the company said. “This is attributable to an increase in the cost of prescription medications.”

The company reported an overall 8.6 percent price increase of prescription medications, including average wholesale price (AWP) increases of 12.5 percent for brand name drugs and 7.9 percent for generics.

The increase in prices for generic drugs was “unexpected” following years of flat levels and the authors expect the increases to continue as newer medications come off patent.

“There were some significant inflationary factors regarding generic product pricing,” the report said. “One of the main contributors to the overall increase in spend was the AWP increase in hydrocodone with acetaminophen combination products.”

“The introduction of higher cost specialty medications will need to be monitored closely, as with the Hepatitis C medications” which came into the arena during 2014.

Last fall, the federal government changed hydrocodone combination products (HCPs) from a Schedule III to the more restrictive Schedule II, the authors noted. While the change has resulted in a “20 percent reduction” in the use of HCPs, “the manufacturers are now required to follow stricter guidance, management and label changes which resulted in an increase to the AWP for the medication.”

Utilization of pharmaceuticals among injured workers decreased by more than 3 percent, according to the report. Included was a reduction in the use of opioids.

“In relation to cost management, HCP price increases were offset by the gains in decreased utilization,” the report said. “The introduction of higher cost specialty medications will need to be monitored closely, as with the Hepatitis C medications” which came into the arena during 2014.

Payers who provide workers’ comp benefits to health care workers have been especially impacted by the rising costs of medications to treat hepatitis C, the authors reported. Each treatment can cost $100,000, and the trend is expected to continue.

Specialty medications that target large claimant populations are being developed. For example, Pfizer Inc. and Eli Lilly and Company are creating Tanezumab. Described as a “new, non-narcotic medication to treat chronic pain,” the drug “has the potential to offer an innovative treatment to help millions suffering from painful conditions.” However, the medication “may add a significant cost to payers who cover chronic pain claimants.”

Compound medications increased in terms of the “number, complexity and cost” in 2014, the report said. “In the past 4 years the average cost of compounds has escalated 225 percent.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected].

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