Prescription drugs represent upwards of 15-18 percent of the total cost of medical care for workers’ compensation claims. While the increase in cost has been problematic, managing the use of prescription narcotics has become even more challenging.
In many cases, these powerful drugs can be overprescribed, especially when taking into account their highly addictive nature. In addition, frequently other prescription drugs are needed to address the side effects caused by longer term use, all while more effective alternative treatments may be available.
Combine the overutilization of these drugs with the high prices associated with some of them and the result is very high total drug costs. In most cases, however, the costs associated with an insurance payer’s workers’ compensation prescription drug costs are derived from a small group of claimants, whereby an average of less than 10 percent of claimants receiving drugs drive upwards of 70 percent of the total prescription spend.
“Workers’ compensation drug treatments need to be closely monitored to ensure that the claimant is getting the most effective and appropriate therapy for the right injury,” says Todd Pisciotti, the vice president of sales and marketing for Healthesystems.
Smart Business spoke with Pisciotti about the impact narcotics have in workers’ compensation and the challenges accompanying this prescribing pattern.
What does a typical prescription treatment pattern look like when treating or managing pain for an injured worker?
Depending on the severity, most workers’ compensation injury-related drug treatments are generally short-term — a worker hurts his back, he is treated by a physician and receives a prescription medication to ease the immediate pain, which coincides with other medical therapy. Ideally, the injury improves and the prescription is no longer necessary. However, the more complex injuries can turn into long-term claims and chronic pain cases. Often drug therapy side effects arise from the extended use of certain medications like trouble sleeping, acid reflux, etc. In many instances, other drugs can be prescribed to alleviate these conditions. However, over time this type of issue can escalate, turning into an ongoing drug treatment program involving multiple prescriptions, many times from different physicians, which may not necessarily be a good long-term solution for the injured worker or for the insurance payer.