Combating the Devastating Cycle of Prescription Cascades and Other WC Drug Cost Drivers

High prescription drug costs are a huge issue in workers' compensation, but there are a few ways to tackle the rising costs.
By: | October 2, 2019

For many Americans, the high cost of prescription drugs is a personal issue.

It’s a personal issue for me — my aunt is diabetic and has been deeply affected by the cost of insulin, which nearly doubled between 2012 and 2016. It’s a personal issue for the millions of Americans impacted by the opioid epidemic as pharmaceutical companies raised the price of Naloxone, the opioid overdose antidote.

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And it’s personal for injured workers and their employers each year as they worry about whether or not they will be able to shoulder the cost of a pharmaceutical market that constantly keeps people asking which drug will be the next to see a price hike.

“First we saw Turing Pharmaceuticals do it with their drug Daraprim which is needed for patients with AIDS. Then we saw EpiPen raise its price to six times the 2004 price. We saw it with Insulin and now we’re seeing it happen with certain forms of Naloxone,” said Phil Walls, chief clinical officer at myMatrixx.

“What comes next? It has become a question of which life-saving drug is going to go through this type of price hike. That alone makes it a concern.”

Together with risk manager Will Franken, director of risk management at Seaboard Corp., Walls will be speaking about the high cost of prescription drugs and how these costs are impacting workers’ compensation at the 2019 National Workers’ Compensation and Disability Conference® & Expo in Las Vegas this November 6-8.

Specialty Drugs Carry Big Costs

One of the areas Walls identified as being a cost driver for workers’ compensation was specialty drugs.

“The specialty pharmaceutical market, which is limited, but it does have an impact on workers’ compensation, is another story. These are all very expensive drugs, but there’s a return on the investment,” Walls said.

Phil Walls, chief clinical officer, myMatrixx

Given the high cost of specialty drugs, however, it takes just one claim for workers’ comp payers to feel the weight of the expenditures. While specialty drugs can be highly effective at treating injured workers, an employee’s failure to take medication can lead to increased costs as prescriptions rack up.

“I heard a saying once and it’s very, very true: ‘The most expensive specialty drug is the one not taken,’ ” said Walls.

“If you’re treating someone for Hepatitis C, and if that patient isn’t compliant with the prescribed regimen, the doctor is going to measure the level of the virus in their system and they’re going to say ‘it didn’t work. We’re going to have to repeat this’ and repeating that course of therapy comes with a price tag of about a $100,000.”

Beware of the ‘Prescription Cascade’

Medications can cause side effects, no matter who or what is taking them. An injured worker prescribed medication with side effects cab lead their doctor to prescribe another medication to treat those side effects.

If the new medication causes other side effects, yet another drug could be prescribed, creating what Walls referred to as a “prescription cascade.”

To try and curb never-ending prescriptions, Walls recommends that workers’ comp payers work with a pharmacist to help prescribers avoid unnecessary prescriptions.

“We start working with that prescriber, developing weaning programs and making timelines and basically just trying to get the patient down to a manageable number of drugs,” he said.

“It’s sometimes felt like an uphill battle, but the physician community — and I think because of all of the media attention on opioids — is definitely much more receptive to a consult with a pharmacist today than they were maybe ten years ago.”

For myMatrixx, pharmacists interacting with prescribers has lead to positive results: “We’ve had very good outcomes. I think the stat that we’ve been quoting lately is that 71% of our interactions with the prescriber on a drug regimen results in at least one positive change,” Walls said.

Working with pharmacists to curb unnecessary prescribing can also help get injured workers off of dangerous drugs like opioids.

“I literally tell all my pharmacists, especially with all the overdoses we hear about, I tell them they are saving people’s lives by getting them off these dangerous drugs when there are safer alternatives available. You can’t put a price value on that,” Walls said.

Generics Bring Savings to Comp

Fortunately, many common drugs for workers’ compensation are either already available as generics or are on their way to becoming generics.

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The recently-expired patent for Lyrica, which is frequently prescribed in workers’ comp for the treatment of nerve pain, has led way to generic versions of the drug entering the market in July.

As the opioid epidemic litigation wears on and Purdue Pharmaceuticals files bankruptcy, Oxycontin might lose its brand-name status as well.

“We basically have an industry that is being able to utilize almost exclusively generic drugs,” Walls said.

While generics can bring cut down on drug costs, most of those savings have already been gained, Walls noted.

“Generics — they’re great for saving money. But like I said it’s just a matter of time before well over 95% of drugs in this industry are or will be generics so there’s little extra to be gained just through generic substitution. And that’s good for everyone because then the focus will be on whether or not the drug prescribed – brand or generic – is the one most appropriate for that patient.” &

About the National Workers’ Compensation and Disability Conference® & Expo:

As the largest National Workers’ Comp and Disability Conference for more than 25 years, NWCDC offers endless opportunities that will propel your workers’ comp and disability management programs forward.  With the biggest Expo in the industry, you’ll be able to touch, compare and contrast the newest solutions from leading vendors in every category, and gain knowledge on-the-go at in-depth sponsored sessions on the show floor. Additionally, NWCDC offers valuable networking opportunities so you can make important contacts and share strategies with your peers.

You can also customize your learning experience with breakout sessions in six distinct program tracks: Claims Management, Medical Management, Program Management, Disability Management, Legal/Regulatory, and Technology. Plus, you’ll hear from Risk & Insurance’s Teddy Award winners for excellence in lowering workers’ comp risk.

Learn more about NWCDC and special savings for Risk & Insurance® subscribers here.

Courtney DuChene is a staff writer at Risk & Insurance. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]