Drug repackagers, compounding pharmacies continue to stress workers' comp systems

The number of physician dispensed prescriptions has declined considerably from just a few years ago, but the workers' compensation industry continues to battle an adapting market seeking to maintain high prices by changing drug strength and formulations.

The number of physician dispensed prescriptions has declined considerably from just a few years ago, but the workers' compensation industry continues to battle an adapting market seeking to maintain high prices by changing drug strength and formulations. Kathy Fisher, assistant director of external engagement at the Workers’ Compensation Research Institute (WCRI), notes a 2017 study examining physician dispensing across 26 states revealed that both prescribing frequency and pricing decreased in all the states studied, except California, Florida, and Illinois. The study examined 2011-2014 data, an important time frame during which reforms were instituted in several states. Twenty-two states have reforms in place. Fisher says that price-focused reforms involved capping high price, repackaged drugs at the wholesale price. Limiting reforms, on the other hand, institutes restrictions to a certain type of drug or for a certain time period. According to Fisher, the study found that prices were static or increased in non or pre-reform states. In all post-reform states, there was a reduction in physician dispensing. For example, in South Carolina, there was a 63% reduction. In Tennessee and Indiana, physician dispensing went down by 23%. Fisher said there was a significant decrease in cost share of physician dispensed drugs to all prescription drugs in many reform states. In states with limiting reforms, Fisher said there was a 12% decrease in opioid physician-dispensed drugs in Kentucky, with similar decreases noted in Indiana and Tennessee.