There are three workers’ comp drug trend reports out this week; we’ll look at each one (in order I received them). A cautionary note; it is difficult to compare PBMs’ performance on the basis of their reports; the metrics and basis for those metrics varies, their books of business are different (some have lots of very old claims, others have more state funds than national clients and there are also other differences in payer mix with some payers much more aggressive and willing to work with their PBM on specific issues).
First up is Progressive Solutions’ version. The big PBM saw an average reduction in spend per claim of 0.5 percent, driven by a combination of fewer days’ supply per script and fewer scripts per claim. Progressive has invested heavily in predictive analytics; the payoff has been a significant drop in opioid usage for targeted claims (15% decrease in morphine equivalents). The data shared in their report parses out the various factors driving claim cost and risk, with “pharmacy behavior”(number of prescribers, number of pharmacies, medications) becoming increasingly significant as a claim ages.
Progressive’s clients are seeing a reduction in opioids as well, with both long- and short-acting opioid script volume down. This has cut per-claim costs for opioids by 4.2 percent.
The report has an extensive and accessible section on legislative and regulatory trends, with discussions of state regs on repackaging, compounds, and physician dispensing.
The takeaways are this:
- Analytics and modeling can drive much better results by focusing resources on the big problems. The PBM and WC industries need to continue to up their game, and get smarter about where, when, and how to address cost drivers – generic, one-size-fits-all approaches are costly, inefficient, administratively burdensome, and annoy claimants and physicians.
- The impact of regulations and legislation on WC pharmacy, and thus workers’ comp costs and outcomes, is increasingly important. Physician dispensing and compounding are two of the biggest profit-creators for those interested in sucking money out of the comp system. It behooves all stakeholders to thoroughly understand these issues and get involved.
- Opioids are being addressed – there’s much to do but a strong focus and assertive programs can and do deliver results.
Finally, Progressive’s report is well-designed and well-written. Kudos to the folks who actually took all that research and translated it into language the rest of us can understand.