Generic Drugs Boosting Pharmacy Costs for Workers’ Comp

Payers are having a tough time slowing the increases of generic drug prices, according to an article in last week’s Business Insurance, by Sheena Harrison.

Ms. Harrison reported that certain generic medications used in workers’ comp claims such as antibiotics, antidepressants and opioid painkillers, have seen price increases ranging from 8.5% to nearly 2,050% (yeah, that’s not a misprint or a typo on my part) in 2014 vs. 2013.

The increases in generic drug prices was revealed in testimony given at a US Senate Subcommittee hearing last fall on rising generic drug prices.

According to Ms. Harrison, Pharmacy Benefit Managers, third-party administrators and other workers’ comp service providers are noticing the higher prices as well.

One such third-party administrator, Broadspire, in Sunrise, FL, said that their average generic prescription cost increased 19% last year compared with 2013, as quoted by Carol Valentic, vice president of cost containment for Broadspire.

According to Valentic, the fourth quarter of 2014 was probably the first quarter that we saw that generic values were creeping up.

In the summer of 2011, I did my internship for my MHA degree with Broadspire in the Sunrise office and one of the projects I worked on was an analysis of physician/pharmacy-dispensed drugs costs within physician provider networks (PPN).

Pharmacy Benefit Manager Express Scripts has also seen price increases for drugs such as pain medications, muscle relaxants, anti-inflammatory drugs and prescriptions for heart disease and high blood pressure.

Monitoring drug utilization is one of the strategies being used to ensure that injured workers get generic medications for the appropriate time periods and dosages, as well as switching patients to cheaper medications that have the same outcomes.

Generic drug prices may be here to say unless federal lawmakers take action, according to the article.

Consolidation among pharmaceutical companies is given by workers’ comp experts as a top contributor to higher prices. They say that pharmaceutical company closures or mergers have allowed the remaining player to boost prices for medications that were previously made by several companies.

We all know that drug costs in the US, both generic and brand-name drugs, are much higher than they are overseas. In fact, my mother worked for a company that helped seniors get their medications cheaper from Canada, the UK, and Israel, so the idea that consolidation or mergers is the culprit is not telling the whole story.

As with the rising cost of health care in general, and the cost of surgeries in particular, it seems that drug costs are making workers’ comp claims costs even more of a problem for the industry to deal with.

When will the industry wake up to the fact that the American health care system is broken, corrupt, and expensive, wasteful, and fiscally out of control?

When will the workers’ comp industry learn, that if something can be had a lower cost with the same or better quality somewhere else, even if that somewhere is in another country, in a medical facility that caters specifically to American and foreign patients, that they should avail themselves of that opportunity?

Strategies such as monitoring drug utilization, as mentioned above, is just one more way the industry is doing the same things over and over again and expecting different results. We all know the real reason our health care system and the workers’ comp system is the way it is, GREED. And the notion that health care is just one more revenue stream, one more profit center for those who have capital and are making money off of the sick and injured of the nation.

I am willing to work with any broker, carrier, or employer who is sick and tired of being bled by the Wall Street vulture capitalists and the entire medico-legal system known as workers’ comp, to save money, and to provide the best care for their injured workers or their client’s employees, while at the same time, helping to break the monopoly of the American health care cartel.

You know where to reach me.

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One thought on “Generic Drugs Boosting Pharmacy Costs for Workers’ Comp

  1. Transforming Workers' Comp Post author

    A quick follow-up. Joe Paduda mentioned on his blog today that a college in Baltimore has set up an educational program to train doctors on physician dispensing. He also said that this comes after Maryland’s recent decision to not do anything about physician dispensing because, according to data collected by DWC, it is not a problem. (http://www.joepaduda.com/2015/02/friday-update/)

    It seems that the entire system is beholden to a recrudescence of greed and profiteering that is destroying the credibility of the workers’ comp industry. Tell me when you wake up and had enough of this conservative rebirth of “free market” piracy.

    Like

    Reply

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