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Big news in work comp pharmacy

Finishing up the Annual Survey of Prescription Drug Management in Workers’ Comp this week (I hope!).  24 payers responded this year – TPAs, Insurers, State funds, and very large employers. Each provided specific data about their pharmacy programs, data which provides remarkable insights into what’s really going on.

Something jumped out at me that I had to get out immediately…

Two big takeaways – drug spend dropped by almost 10 percent…

while opioid spend decreased even more – almost 14 percent.

Wrap your head around that.

Work comp PBMs and payers succeeded in eliminating one of every seven dollars spent on opioids; yes, overall drug spend was down a full 10 percent, driven in large part by lower utilization of opioids.

When opioids are eliminated, the drugs needed to counteract their awful side effects – everything from constipation to sexual dysfunction to gastrointestinal distress to depression – are reduced as well.

The programs, processes, analytical resources, clinical staff, research, and patient outreach that’s driven this stunning result are largely PBM-delivered (with some notable exceptions).  These services are clearly improving the quality of care delivered to work comp patients, while reducing costs for employers and taxpayers.

shipload of opioids has been taken out of circulation, eliminating the possibility of diversion, misuse, or abuse.

What does this mean for you?

Healthier patients, lower costs, reduced disability. 


5 thoughts on “Big news in work comp pharmacy”

  1. Joe, you make some excellent points about the mitigation of the use of narcotics in our WC space. It is true that PBM’s continue to bring value to assist in this mitigation. There are also some great companies who specialize in helping to reduce narcotic costs through weaning and other methods. though not affiliated with PBM’s.
    As of this point I have not seen any good data on the number WC cases settled which shifts the payments out of our system and into standard health benefits (somewhat funded by the settlement). These “settled” dollars are not captured in our data.
    Success has different definitions and while we are helping injured workers to be healthier we also may be moving some of the spend out of the system.

  2. Joe, Do you think that treating physicians may have had a hand in the opioid decrease? Perhaps some of them should receive some thanks as well.

    1. Steve
      As many of these docs were the ones prescribing far too many opioids in the first instance I’m not sure that credit is due nor warranted.

      If you set the fire you don’t deserve plaudits for putting it out.

      1. I agree to a large part regarding the above comment, however, many physicians were told inaccurate and misleading information regarding the addiction potential and ease of weaning if the patient became dependent. Those physicians who were acting to the best of their knowledge, and when presented with new evidence based information, changed course, I do believe deserve credit. Thanks as always for your timely sharing of important information.

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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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