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Drug costs in workers comp – and the answer is

I’ve just about completed compiling results of the Fifth Annual Survey of Prescription Drug Management in Workers Comp. While the report won’t be completed for a couple weeks, here are a few factoids that are rather compelling.
Drug trend continues to moderate, with inflation in 2007 coming in at 4.3%. That’s a big improvement over last year’s 6.5%, which was a big improvement over the previous year’s 9.5%…
Generic fills (the percentage of scripts that are filled with generics) looks to be in the high seventy percent range, with generic efficiency around 90% (that’s the percentage of scripts that could be filled with generics that are).
New this year is a question about first fill capture rate, defined as the percentage of initial scripts that are routed through the PBM’s network. This is starting to get attention, with the average respondent rating it just under ‘very important’. That doesn’t mean they have the data – about half of the twenty payers surveyed couldn’t identify their first fill rate. Of those who could, the numbers indicate about one-fifth of initial scripts are in-network.
Many of the survey respondents (primarily large and mid-size carriers, state funds, and TPAs) have a lot more insight into their drug spend, know what the cost drivers are, and the ones with the lowest inflation have all put programs in place to clinically manage drugs.
Thanks to all the folks who set aside time to help with the survey – you know who you are.

2 thoughts on “Drug costs in workers comp – and the answer is”

  1. Joe,
    Are you sure about that high seventies figure for generic fills? If so, I’d be interested in how that’s accomplished. Seems too good to be accurate.

  2. Dr. Jake – the number is pretty consistent across payers, as is the generic efficiency rate. I’ll be publishing the data range in the respondent report, which Broadspire will receive. Let me know if you have other questions.
    Joe Paduda

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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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