The goal of this ongoing series has been to segment and analyze major contributors to pharmaceutical spending in workers’ compensation. Especially in the past few years, prescription drug prices have received considerable attention from the media and in the health care and workers’ compensation systems. By identifying and addressing the real cost drivers in workers’ compensation pharmacy, claims professionals, payers and plan managers can develop and implement more effective cost-management strategies with the help of pharmacy benefit manager (PBM) partners.
Our final two Demystifying Drug Pricing series topics are now available for download:
Part Three: The Impact of Specialty Drugs (Download)
In health care, specialty drugs have become a primary driver in pharmaceutical spending over the past five to 10 years. These are medications with a potential price tag in excess of $100,000 for a single claim. Even as spending and utilization of specialty drugs increased, many experts predicted that the impact on workers’ compensation would be minimal. However, with more specialty drugs being developed for a wider range of conditions, this category will more than likely have a substantial impact on work-related cases over the next decade.
Biologicals, a subset of specialty drugs, have complex molecular structures derived from living organisms. Unlike conventional medications, substituting them with generics is difficult due to their complex manufacturing processes. Enter biosimilars: designed to closely mimic biologicals, they offer potential cost savings. In Part Three: The Impact of Specialty Drugs, we examine how biosimilar use in workers' compensation will affect pharmaceutical spending.
Key report takeaways include:
- Defining specialty drugs (including biologicals and biosimilars) and how they impact the workers' compensation industry
- Cost drivers such as specialized administration, lack of generic equivalents and more
- Effective cost-reduction strategies to reduce waste and promote positive treatment outcomes
Part Four: The Current State of Physician Dispensing and Compounding (Download)
Physician dispensing has grown since 2016 to become a significant cost driver in workers’ compensation drug spending, especially in states without laws limiting this practice to some degree. Although tremendous progress has been made in some states through legislative changes, compounding continues to require close attention and scrutiny, especially in the subcategory of private label topicals.
Physician dispensing involves directly providing medications to injured workers from medical facilities instead of pharmacies, while compounding entails altering drug ingredients to meet specific patient needs. While both physician dispensing and compounding have legitimate applications, these practices raise concerns about cost-effectiveness, particularly when prescription topicals are involved. In Part 4 of myMatrixx's Demistifying Drug Pricing series, you'll gain insight into medication dispensing trends within workers' compensation and learn strategies to reduce costs.
Key report takeaways include:
- The growing overlap trend of physician dispensing and compounding
- How legislative action has helped curtail unnecessary physician dispensing
- myMatrixx clinical resources that help control costs and promote safety for injured workers