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The year 2020 started with the buzz of a show called Tiger King. Then came the murder hornets, multiple wildfires and an election season that held our attention. However, it was the COVID-19 pandemic that overshadowed them all and, for most of us, dramatically changed the way we live, play, and work.

Data Methodology Analyses
2019-2020 Paid workers’ compensation transactions
>700,000 claims
~ 6.5 million in-network prescriptions
Prescriptions captured through network enforcement solutions
Excludes clients with less than a two-year history in our program

The COVID-19 pandemic also impacted our book of business. As the pandemic’s reach escalated, the economy and country halted. With a lower demand for non-essential products and services, fewer people were going to work in offices, warehouses, manufacturing centers, and hospitality locations, our country’s unemployment rate exploded exponentially. And subsequently, in our industry in particular, claim volumes dropped. At Optum, our data reflected the same trends with claims dropping by double-digit percentages. Without the influx of new claims into the mix, the older, established, chronic cases began to dominate our data trends.

It was definitely a different year.

In the following content, we’ll take a look at how the pandemic and the older claims impacted medication and opioid utilization and spend in our population of injured persons. We’ll also provide insight on how our programs and services were able to adjust in this changing tide to help our clients manage their claims to achieve positive outcomes.

Through the very different year, Optum is still making a difference.

Claim age made an impact in 2020

With fewer new claims in 2020, the Optum 2020 book of business claim age increased 14.9% over the previous year. It was this that contributed to increases in medication utilization and spend.

The longer a claim remains active with continuing and progressing treatments, the greater the possibility for longer days of supply, multiple medications, drug interactions, complications from comorbid conditions, multiple prescribers and providers, overall higher risk and in turn, higher costs. This proved true with our book of business, as while our 10+ year-old claims made up 18.9% of claims they accounted for 47.5% of prescriptions and nearly 62% of overall costs.

CLAIM AGE 1 YEAR

CLAIM age 10+ YEARs

Despite the trend of increasing 10+ year old claims, the Optum clinical and claim mangement programs made a difference, driving the percentage of opioid utilization down.

Claim age drives costs and utilization

One-year old claims make up 43.7% of claims but only 16.3% of prescriptions.

10+ year old claims make up 18.9% of claims but 47.5% of prescriptions.

opioid
utilization

Optum continues to make a difference in opioid utilization.

As stated earlier, older claims often have greater days of supply, higher-cost brand medications and elevated utilization of medications – including opioids. In 2020, this manifested as a 10% increase in opioid utilization. But, with formulary management, strategic communication to providers and prescribers, clinical oversight, informative analytics and regulatory actions, we were able to hold our average MED per claim just under 47 and below the 50 MED recommendation for acute claims by the Centers for Disease Control.

Opioid spend was also down 1.1% from last year at 21.5% and for the eighth year in a row, our percentage of claims using opioids continued to drop, now dipping to 38.5%.    

CHANGE IN UTILIZATION

up10.0%

MED
PER CLAIM

46.9

OPIOIDS AS A % OF TOTAL SPEND

21.5%

% OF CLAIMS
USING OPIOIDS

38.5%

Percentage OF CLAIMS USING OPIOIDS year over year

Still making a difference in 2021 and beyond

While 2020 is over, much of its influence is hanging on into 2021.

At the time of this report, we are still in the midst of the pandemic and another surge, but hopeful signs near as populations stand in line for their vaccinations, employers begin to open their doors and the economy shows signs of recovery. No matter what the future holds, as your partner, Optum is committed to:

  • Keeping you informed of how COVID-19 is impacting the industry and your business
  • Finding new ways to communicate with our clients to assist, educate and inform
  • Engaging with our network providers on the issues and concerns in workers’ compensation
  • Making sure your injured persons receive the right medication or treatment, when they need it, for as long as they need it, safely and effectively
  • Monitoring the issues like aging claims, treatment advancements, and legislative agendas
  • Managing the trends of today and tomorrow including the utilization of; opioids, medical and recreational marijuana, wellness and behavioral health treatments, and virtual medicine

Most of all, we are committed to making a difference for your business and your injured persons.

For more information on the Optum 2020 book of business…

Click the links below for our Key Pharmacy Findings, Average Wholesale Price, the Top Therapeutic classes and their Top Medications in 2020.

Key 2020 Pharmacy Findings

The jump in claim age in 2020 led to a 6.6% increase in average prescription cost per claim, a higher average days of supply and higher number of scripts per claim. This was topped off with a slightly higher Average Wholesale Price, or AWP.

OPTUM 2020 EXPERIENCE (difference from 2019)

AVERAGE RX
COST PER CLAIM

up6.6%

SCRIPTS
PER CLAIM

up7.6%

AVERAGE DAYS SUPPLY/RX

up4.6%

OVERALL AWP INCREASE

up1.9%

Average Wholesale Price (AWP)

Along with the 1.9% overall increase in 2020 we saw no increase in generic AWP and a 4.8% increase in Brand AWP, which are all 10-year historical lows. 

10-year historical AWP for overall,
brand and generic medications

2020 Top therapeutic classes

In 2020, while opioids remained the top therapeutic class for both number of prescriptions and total spend. There were slight variations in number of prescriptions and total spend for the other therapeutic classes compared to the previous year, most notably increases in the anticonvulsant, dermatological and antidepressant categories.

The increase in antidepressants may be influenced by the pandemic and its impact on the injured person’s employment, recovery and wellbeing as the increase appears statistically significant in its rise.

Top 10 therapeutic classes ranked by total prescriptions

Top 10 therapeutic classes ranked by total spend

2020 Top medications

Hydrocodone/APAP continues to top the list in number of prescriptions. Pregabalin was the top medication by spend due to its use in workers’ compensation even as a recently released generic. The antidepressant, duloxetine, retained its #5 rank according to overall spend in 2020.

Top 10 medications by number of prescriptions

2020
Rank
2019
Rank
Common Brand Name Generic Name Therapeutic Class
1 1 Vicodin, Norco tablet hydrocodone-acetaminophen Opioid Analgesics
2 3 Neurontin capsule gabapentin Anticonvulsants
3 2 Motrin, Advil tablet ibuprofen Anti-Inflammatories
4 4 Flexeril tablet cyclobenzaprine Musculoskeletal Therapy Agents
5 5 Percocet tablet oxycodone-acetaminophen Opioid Analgesics
6 7 Mobic tablet meloxicam Anti-Inflammatories
7 6 Ultram tablet tramadol Opioid Analgesics
8 8 Lyrica capsule pregabalin Anticonvulsants
9 10 Roxicodone tablet oxycodone Opioid Analgesics
10 11 Cymbalta capsule duloxetine Antidepressants


Top 10 medications by spend

2020
Rank
2019
Rank
Common Brand Name Generic Name Therapeutic Class
1 1 Lyrica capsule pregabalin Anticonvulsants
2 2 Oxycontin tablet oxycodone ER Opioid Analgesics
3 3 Percocet tablet oxycodone-acetaminophen Opioid Analgesics
4 4 Lidoderm patch lidocaine Dermatologicals
5 5 Cymbalta capsule duloxetine Antidepressants
6 6 Celebrex capsule celecoxib Anti-Inflammatories
7 7 Neurontin tablet gabapentin Anticonvulsants
8 8 Vicodin, Norco tablet hydrocodone-acetaminophen Opioid Analgesics
9 9 Neurontin capsule gabapentin Anticonvulsants
10 10 Mobic tablet meloxicam Anti-Inflammatories

PREVIOUS REPORTS

2019 Trends Report

With 44 years of leading pharmacy care services, Optum workers’ comp continues to enhance our programs and services to answer the needs of our clients and industry.

2019 MID-YEAR Report

Our full mid-year report describes the importance of our Total Care Management Solution and how we anticipate a shift toward alternative pain control treatments.

2018 TRENDS REPORT

2018 was another successful year and led to positive outcomes for our payers and for the industry. We expand on how this may impact ancillary, PPO and settlement solutions.