A Healthesystems publication

Spring 2012

Additional Data

Included below are insightful analytics and useful tools relating to workers’ compensation pharmacy benefits management. These graphics are intended to supplement the data provided in this publication and provide added insight into managing workers’ compensation drug cost drivers.

Morphine Equivalent Dose, or MED, is a method of comparing the strength of opioids in relation to the drug morphine. The opioid scale illustrates how some of the most commonly prescribed drugs in workers’ comp compare in strength using morphine as a baseline.

Managing drug utilization and controlling costs requires communication, education and interaction of all stakeholders in the claim process. The chart below illustrates the central role in which the PBM plays in managing this critical process.

This graphic illustrates the importance of early intervention for controlling opioid drug costs. Over a 15 year period, opioid drug costs per claim increase sharply, especially after the first five years. As illustrated in the chart below, when analyzing the actual drivers of opioid cost over time, the major contributors are the increases in drug mix (potency) and in dosage amounts, while utilization (i.e., the number of scripts and pills dispensed), by comparison, is relatively small. It’s the “incremental” increase in dosage and drug mix that begin manifesting during years 3 to 5 where the dramatic growth in costs per claim occurs.

The chart below illustrates the comprehensive elements required to support a proactive opioid management strategy. Prescription opioids can comprise anywhere from 25 to 40 percent of a payer’s total annual prescription drug cost. Therefore, it is critical to implement a strategic opioid management program capable of quickly identifying at-risk claims. The use of early detection, early intervention tools are proven to alter the costly and often unproductive path treatments may frequently follow.

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