Getting Ahead of the Trends

The world of workers’ compensation prescriptions is constantly evolving, and with new trends and developments emerging, there are several key points worth watching in the year ahead. From changes in physician dispensing to the impact of long COVID on prescription drug usage, here are the top workers comp prescription trends to watch out for in 2024.  

MENTAL HEALTH  

Mental health is a focus area for many organizations, and it shows no signs of slowing down in 2024 and beyond. Currently, the insurance market has embraced normalizing discussions about mental health issues and people are more comfortable seeking treatment.  

Over the last few years, there has been an increase in prescriptions written for beta blockers and anti-anxiety medication. It is anticipated that these will continue to progress now that mental health is part of open discussions and can directly affect an injured worker’s recovery.  

As more individuals seek treatment for mental health conditions, it raises questions about how workers’ compensation insurance carriers will manage these types of claims and their impact on pharmacy utilization, which will also be significant if mental health claims are deemed compensable. In addition, it will be important for insurance carriers to develop strategies to effectively manage claims and ensure appropriate access to medications for those in need.  

OPIOID UTILIZATION  

While opioid utilization has been declining over the last five to 10 years, tighter control and restrictions are needed. Many experts are monitoring the impact of the updated 2022 CDC guidelines, which provide recommendations for opioid prescribing. Understanding how these guidelines affect opioid dispensing practices and patient outcomes will be essential to addressing the ongoing opioid crisis.  

Given their high cost and highly addictive nature, opioids also require higher payouts. Workers’ compensation teams are developing better programs from a clinical perspective, reaching out to prescribing doctors and incorporating peer-to-peer reviews of prescribing patterns. In many cases, the prescribing pattern is warranted; however, when someone has been utilizing opioids for a period of time, it is important to review the case to ensure adverse consequences are mitigated in the future. Additionally, new research about how opioids interact with other medications, such as Gabapentin, is also being considered in prescription safety.  

PHYSICIAN DISPENSING AND HIGH-COST TOPICALS  

Physician dispensing provides a convenient way for medications to be dispensed directly from the doctor to the patient, bypassing traditional pharmacies. However, it often comes at a higher cost, especially when low-cost alternatives exist in over-the-counter options. It is important to educate patients about alternatives and encourage them to explore cost-effective options before resorting to physician-dispensed medications.  

Today, every state has different guidelines, fee schedules, and regulations around physician dispensing practices. Insurance providers and brokers are monitoring the impact of recent and ongoing legislation that aims to regulate physician dispensing, and it will be vital in understanding the potential effects on cost and utilization going forward.  

IMPACT OF LONG COVID ON PRESCRIPTION COSTS  

The long-term effects of COVID-19, often referred to as long COVID, are still not fully understood. As more individuals experience prolonged symptoms and complications from the virus, it raises questions about the impact on prescription drug usage. It has yet to be determined how these types of claims will progress over time and the specific impact on prescription medications. Monitoring research and studies on long COVID is necessary to gain a comprehensive understanding to address the potential implications for prescription trends in 2024, especially as they relate to workers’ compensation.  

INFLATION  

Inflation has been a significant concern across various industries, but its impact on average wholesale price (AWP) drug costs has been relatively limited compared to other sectors. It is important to consistently evaluate the impact of inflation on prescription drug costs over time. Understanding how inflation influences drug pricing and reimbursement will be crucial in ensuring affordable access to medications for patients.  

As we approach 2024, these top workers’ compensation prescription trends will shape the pharmaceutical landscape. From the impact of physician dispensing and high-cost topicals to the management of mental health claims and the ongoing challenges of opioid utilization, staying informed and proactive will be key for healthcare professionals, payers, and patients alike. By keeping an eye on these trends, we can work towards improving patient outcomes and ensuring the effective and efficient use of prescription medications.