To Save On Rx Claims, Focus on Long-Term Injury, Study Says

A drug provider said a survey of its database has found there is less potential for savings on the initial prescription given workers after an injury and the focus should be on medication for employees with a long-term condition.

Tampa, Fla.-based PMSI, which describes itself as the nation's largest provider of pharmacy products for workers' compensation, found that only 35 percent of injured workers who receive a prescription are those getting a first medication, accounting for less than 18 percent of total prescriptions and less than 5 percent of the total savings potential.

Nick Page, PMSI vice president of pharmacy services, noted that "the workers' compensation community has been enthusiastic about the cost savings potential of first-fill," initial prescriptions.

"However," he said, "our analysis finds that this first-fill prescription is a very small percentage of overall costs and the real cost savings opportunity lies in clinical pharmacy management for the chronically injured worker on long-term medication."

PMSI said analysis of its pharmacy database focused on savings opportunities within workers' comp claims.

The company said its pharmacy database is the largest in the industry, representing nearly 12.5 percent of the total workers' comp annual drug spend. As such, the data provides the most comprehensive source for workers' comp payers, the company said.

The analysis focused on the first-fill prescription, or the initial pharmacy prescription immediately following an injury and before the claim is made to the insurer. The analysis also took into account the ongoing costs associated with chronically injured workers.

Among the key findings:

o Only 35 percent of injured workers who receive a prescription fall into a first-fill scenario, accounting for less than 18 percent of total prescriptions, less than 8 percent of total pharmacy costs and less than 5 percent of the total savings potential.

o Chronically injured workers--those who remain injured for four years or more--represent only 17 percent of all injured workers but account for 45 percent of all workers' comp prescriptions and nearly 65 percent of all pharmacy costs.

"This means that the pharmacy needs of the chronically injured worker represent a whopping 65 percent of the savings opportunity," PMSI said in a statement.

According to the company, its finds reveal a need for a major shift in focus within the industry in relation to areas of potential cost savings.

PMSI advised that "to realize the most significant cost containment, it is critically important to employ pharmacy programs and services that manage network and prescription utilization for the chronically injured worker. Overall, a balanced pharmacy program must have an appropriate focus on first-fill but a stronger focus on the chronically injured worker."

PMSI is the single-source solution for workers' comp serving as a full-service network provider of pharmacy, Medicare Set-Asides, medical services and equipment, and clinical services.