Column: Workers' Comp

A Matter of Choice

By: | June 2, 2014

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

Certain things are a given. For example, the public rarely views the insurance industry favorably, no matter its record for paying claims. Another given: Choices about health care are always personal.

So it was easy to foresee the outcome when pollsters asked, “In the event that you were injured on the job, where would you prefer to fill your prescriptions during a workers’ compensation claim: a pharmacy provided by your insurance company or a pharmacy of your choice?”

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A Massachusetts-based company called Injured Workers Pharmacy, or IWP, sponsored the poll of Pennsylvanians and is lobbying for legislation in several states that would guarantee workers’ comp claimants the right to choose their own pharmacy.

IWP specializes in mail delivery of pharmaceuticals to injured workers. Its proposed legislation is opposed by the Property Casualty Insurers Association of America and pharmacy benefit managers.

Sure, if I had little or no knowledge of workers’ compensation, like most people I meet, I too would quickly respond to the poll question — as did 78 percent of the 622 respondents — by saying I want to decide where to fill my prescriptions.

But knowing a little about the pharmaceutical-related issues that workers’ comp payers and injured workers face, it strikes me that the question was posed in a vacuum, capturing responses from those unaware of the complex problems driving costs and treatments in the workers’ comp world.

When I think of those complex problems, I am more willing to agree with allowing workers’ comp payers a say in how I would obtain my prescriptions.

That’s why I suspect that the employee-choice legislation, already adopted by some states, might be more about a business model competing for a piece of the prescription distribution pie than about injured workers.

The complex problems I mentioned are well known to workers’ comp payers.

They include the growing dispensing of compound medications when less-costly commercially available alternatives often exist. The average cost of those prescriptions shot up 29.8 percent to $1,299 per prescription from 2012 to 2013.

Meanwhile, the percentage of injured workers receiving compounds increased from 1 percent to 2 percent during the same period. That is a concerning trend workers’ comp payers need to address.

There is also the opioid issue. Evidence suggests that prescribing opioids in new worker-injury claims has flattened or decreased slightly. That has come in part because of workers’ comp payers working with pharmacy benefit managers to detect and question the need for prescribing of opioids in many cases.

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But IWP’s business model upends that process by circumventing measures PBMs put in place, such as collecting prescription data at the point of sale.

Ken Martino, IWP’s president and CEO, said his company’s business model does a better job than PBMs in helping manage injured employee care by working directly with doctors and patients. PBM practices are outdated, he said, and the legislation his company lobbies for is indeed about freedom of choice.

But as lobbying efforts for pharmacy choice legislation continue, lawmakers should ask how such measures will impact pharmacy utilization and employer costs.

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