The Evolving Dynamics of Pharmacy Use in Workers’ Compensation

The landscape of pharmacy use in workers’ compensation is an area of constant evolution. A recent discussion between Michelle Kerr, chair of National Comp, and Johnny Taylor, AVP at Gallagher Bassett, highlighted the top five pharmacy trends to watch in 2024.

Physician Dispensing Challenges: Physician dispensing remains a primary concern, particularly with the high costs of topicals and creams dispensed directly from clinics. These often have over-the-counter alternatives but are priced much higher. To address this, edits and controls with pharmacy benefit management partners have been implemented to manage out-of-network bills and streamline prior authorization requests.

Behavioral Health and Workers’ Comp: Mental health awareness is increasing, and its implications for workers’ compensation are significant. Antidepressants and anti-anxiety medications are accounting for a larger portion of total spend. The industry is adapting to manage these claims effectively, focusing on holistic approaches and expanding provider networks, despite resource shortages.

Opioid Utilization: The opioid crisis remains a critical issue. Efforts have been made to reduce opioid prescriptions and monitor their use. Regulatory impacts, such as limiting supply and updated CDC guidelines, have helped to maintain a downward trend in opioid use within workers’ compensation.

Impact of Long COVID: Long COVID presents a new challenge, potentially affecting pharmacy utilization for an extended period. Specific trends in respiratory and heart-related medications are being monitored to understand and manage these claims.

Inflation and Pharmacy Costs: Inflation is expected to impact the average wholesale price of medications, leading to increased costs even as utilization might decrease. Effective cost-containment strategies and utilization management will be crucial for employers and payers.

Overall, the focus is on effective utilization management, ensuring appropriate prescription use, and designing programs to mitigate misuse and abuse. The evolving pharmacy landscape in workers’ compensation requires continuous monitoring and adaptation to these emerging trends.