Trends Shaping Workers' Compensation

A 2017 review of the prevailing industry trends impacting pharmacy outcomes

2017 overall cost and utilization trend

When analytics, clinical tools and expertise, network enforcement, and advocacy in government affairs harmonize, positive change is the result.

Overall numbers

The 7.2 percent reduction in average prescription cost per claim highlight the ongoing importance of working collaboratively to control both cost and utilization. These metrics both declined over the period.

Note: An analysis of paid, in-network workers’ compensation prescription transactions managed during the twenty-four month period, 2015 - 2016, associated with more than 500,000 claims indicates average wholesale price inflation has returned to more historical levels.

Average wholesale price

The weighted and combined overall increase in AWP was 6.1 percent, influenced significantly by a 14.1 percent rate of inflation for brand-named medications. The rate of AWP inflation for generic medications was 0.3 percent. This low represents a return to more traditional levels of AWP inflation.

Generic utilization

In 2016, generic utilization increased to 85.3 percent. This is the fifth year in a row generic utilization has increased. Meanwhile, generic efficiency remained strong at 99 percent. Such persistency is indicative of very capable programs, particularly point-of-sale and formulary controls which drive better utilization of generic medications when available and possible.

​Opioid analgesics

Collaborating with payers, educating claims professionals, alerting pharmacists, and communicating with prescribers contributed towards the favorable reduction in the utilization of opioid analgesics. Fewer claimants are using opioid analgesics and their associated MEDs are down 6.8 percent this period. Working with our clients to manage pain and the corresponding use of opioid analgesics, has resulted in a 2.6 percent decline in utilization.

Through the use of our PBM controls, the number of opioid analgesic prescriptions per claim has fallen 14.8 percent since 2012. More importantly the number of injured workers using opioid analgesics is down 10.2 percentage points and the MED per claim is down 12.2%. The five-year trend also shows a 23.2 percent decline in days’ supply per user, per year.

​​Compounded medications


The use of compounded medications, and their associated costs, continue to decline. Data show utilization is now below 2012 levels, demonstrating a multifaceted approach to managing their use, inclusive of regulatory reform, is resulting in safer, more efficacious and cost-effective care.

​​​Specialty medications

The number of claims has not increased over the five-year period 2012-2016, however, the average cost per prescription has risen 28.2 percent and total spend associated with specialty medications has increased 59.9 percent. These results reaffirm we must continue to proactively manage use and monitor for changing trends.


​Looking ahead

For the last several years, Optum has been tackling the biggest challenges in workers’ compensation pharmacy benefit management by collaborating with our clients and other stakeholders throughout the system. These efforts are delivering promising results. Looking forward, we will continue to work together to help ensure claimants receive the right medications at the right time, throughout the claim lifecycle. Specific to the remainder of 2017 and into 2018, we are engaged in efforts addressing industry trends, including:

  • opioid analgesic utilization management
  • expanded use of statistical analysis in claim management
  • state-based formularies and other regulatory changes
  • applicability of alternative therapies in chronic pain management
  • enhancement of claims management portal technologies
  • stakeholder education
Through these and other efforts, we will continue to evolve our pharmacy care services and make a positive difference in the lives of those we serve.

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