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A few facts about Pharmacy Management in Workers Comp

I’m knee deep in my annual survey of pharmacy management in workers’ comp, and if I look at one more column of data I’m going to need a few class 2’s myself.
So in the interest of my sanity, here are a few early findings from the survey.
Inflation looks to be down from last year’s 6.5%, marking the fifth consecutive year of ‘decreases in the rate of increase’. More detail to follow on what’s causing the decline, but preliminary review indicates the focus on utilization is continuing to reduce the volume and type of drugs dispensed. As NCCI has noted, utilization is significantly more important cost driver than price.
Clinical programs are getting better, more targeted, more sophisticated, and more effective. A focus on addressing high cost claimants is almost universal among the best performing payers – this may seem blindingly obvious, but requires one to have data, know what to look for, and be able to develop and implement programs to attack the issue.
I try to use the same questions each year so we can track trends and changes in the industry. But new things, points of interest, and queries come in each year which requires that some old and not-as-interesting-any-more questions have to get dropped to make room for the new stuff.
This year we added questions on generic efficiency and fill rates. While the analysis is not yet complete, and a couple more respondents are going to send their data in, the preliminary figures indicate the average generic fill rate is right around 70%, with generic efficiency (the percentage of scripts that could be filled with generics that are) around 90%.
This is an average – types of business written and managed, jurisdictional nuances, data availability, accuracy, and consistency all make this stat somewhat questionable.
That said, better to start asking then to wait for perfection.
Thanks to Cypress Care for sponsoring the survey for the third consecutive year.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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