NCCI Reports Downward Trend for Workers’ Compensation Prescription Drug Costs

Topics: Agent Resources

Opioids like fentanyl, oxycodone and morphine have long been the go-to medications for managing pain for both short- and long-term relief from the injuries sustained as part of a workplace accident. The greater prevalence of payments for opioids in workers’ comp claims is a direct result of the types of injuries involved, which are often debilitating and lead to chronic pain.


NCCI’s Workers’ Compensation and Prescription Drugs Report


The National Council on Compensation Insurance (NCCI) recently released The Workers Compensation and Prescription Drugs 2018 Update, detailing the impact of prescription drugs on workers’ compensation costs. Key insights from the report:
  • The prescription drug portion of workers’ compensation medical costs is 13.7% in 2016, which is down 4%.
  • Utilization, the difference between the change in costs per claim and the change in prices of prescription drugs, is the main contributor to the decreases in 2015 and 2016.
  • Opioid costs per active claim have declined in 2015 (3%) and 2016 (7%).
  • Physician dispensing and brand name costs per active claim have also declined in 2015 and 2016.
  • Top three drugs - Lyrica, OxyContin and Gabapentin - account for more than 15% of prescription drug costs in 2016.

While there is still an opioid crisis in the U.S., the report points to better outlook in the use of these drugs in workers’ compensation claims. In fact, 2016 is the fifth consecutive year during which opioid utilization has decreased. The report shared that the positive trend towards lower usage can be attributed to:
  • Recognizing the addictive nature of opioids and the possible risks of prolonged opioid use.
  • Utilizing evidence-based guidelines, commonly known as drug formularies, to reduce the over-prescribing of opioids, contain drug costs and improve return-to-work outcomes.
  • Educating doctors on safer alternatives for treating injured workers’ pain without the use of medication.


AmTrust Opioid Prescription Risk Report


The NCCI report shows positive gains are being made in managing opioid and prescription drug costs in workers’ compensation cases, but emphasized more can be done by proactive claim handlers. AmTrust Financial partnered with Optum Workers’ Comp and Auto No-Fault, a pharmacy care management company, to implement an innovative program to improve outcomes and reduce opioids prescribed to injured workers.

Over the last year, AmTrust adjusters and licensed nurses at Optum have worked together to review claims and take a proactive stance against the opioid epidemic. The program reduced the number of prescriptions containing opioids by 13,000 compared to the prior year and assured that claimants are receiving the right treatment, at the right time and for the right duration. Additionally, AmTrust has seen a drastic reduction in the percentage of opioid-related claims, dropping from nearly 60 percent in Q4 of 2017 to just under 25 percent in Q4 of 2018.

The results of the program can be found in our newly released AmTrust Opioid Prescription Risk Report. Download the report to learn more about the effects of the opioid epidemic on workers’ compensation claims, and take a deeper look into the progress that the AmTrust and Optum partnership has achieved in reducing claims with opioids and replacing these with safer, alternative treatments.

AmTrust has the resources and insight to create customized workers’ compensation insurance solutions for every customer. For more information on small business insurance solutions, contact us today.

This material is for informational purposes only and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Coverages may vary by location. Contact your local RSM for more information.
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