2020 in Review — myMatrixx Navigates the Effects of the Pandemic on WC Pharmacy

Now that the workers’ comp industry can begin to fully analyze the impact of the pandemic and all of the ripples it has caused in the economy and workforce, we’re seeing many things we expected — along with some surprising results. First, most experts predicted a significant reduction in new claims as a result of both job loss and the shutting down of physical worksites. This definitely came to pass, with estimates pointing to a 19.3% drop-off in new claims in the first half of 2020.¹ 

As is often the case, deeper analysis of even expected trends can show results that were not anticipated or explain anomalies that don’t look connected on the surface. That’s why even as people begin to return to work in a restarting economy, it’s critical to take the time to analyze the results of such an unusual year. The clinical team at workers’ compensation pharmacy benefit manager (PBM) myMatrixx, did exactly that as they prepared for the release of their annual Drug Trend Report. 

"Any report on drug trend data in 2020 had to address the effects of the pandemic,” said Phil Walls, Chief Clinical Officer for myMatrixx. “However, it was also still important to keep our focus on the many other concerns in workers’ comp pharmaceuticals that did not go away just because of COVID.” 

Even topics in workers’ compensation that did not have a direct connection to COVID, such as behavioral care or opioid misuse, were still impacted. That is why any attempt to understand the state of the workers’ comp pharmacy space has to begin with a discussion of the pandemic, including pharmaceutical treatment for COVID-19 and the effect it had on overall statistics. 

How COVID-19 affected workers’ comp pharmacy spending 

Throughout the past year, there has been an ongoing discussion on COVID-19 coverage and presumption in workers’ compensation. Like any other part of workers’ compensation law, these decisions are being made at the state level, with many states making decisions to include workers including first responders exposed to COVID-19 as compensable in claims.² 

This means it was important for PBMs to take a close look at how these decisions impacted overall pharmacy spend. “On the retail pharmacy side, we found there was not a major impact on spending for COVID treatment,” said Brian Williams, a myMatrixx Clinical Pharmacist. “Most of the major medications used in treating COVID are administered in the hospital, which is not processed through a PBM.” 

Williams continued, “On the retail side, the medications dispensed were primarily for symptomatic treatment and represented less than a percent of total drug spending last year.” Walls elaborated, “Asthma inhalers such as albuterol and anti-inflammatories such as dexamethasone were specific treatments that saw an uptick in utilization.” 

While treatment may not have a large impact on workers’ compensation retail spending, one of the most pronounced effects of the pandemic was caused by the decline in new claims on overall utilization at the per patient level. 

COVID distortion — identifying a crucial utilization shift 

Although the large decline in new claims was expected, like other big events, the full impact it was going to have on the data is only now just being understood “When we looked at the 2020 numbers, one noteworthy result was an apparent increase in utilization and spend at the per-patient level,” explained Walls. “Along with our partners at Express Scripts, now a part of Evernorth, we took a closer look at this trend to find the underlying cause.”   

What they found was actually a statistical shift related to the precipitous drop-off in new claims. As Williams put it, “Newer workers’ compensation claims are associated with decreased drug utilization and spend, so when the pandemic caused new claims to go down, we also removed the lowest utilizers.” Added Walls, “We labeled this 12.2% increase in average prescription utilization per injured worker the ‘COVID distortion effect.”

Williams emphasized the importance of identifying a trend like this, “The good news here is that by isolating this effect, we can more clearly show how we did keep the pressure on drug costs in a historically difficult year”. Elaborated Walls, “Overall, myMatrixx was able to achieve a 2.6% decrease in cost per days’ supply in spite of the COVID distortion effect.” 

Finding a place for behavioral health care in workers’ comp 

The pandemic and resulting quarantine caused many in health care to take a closer look at the effects that increased isolation and uncertainty about the future would have on mental health. Predictably, last year saw noticeable spikes in anxiety, depression and insomnia, among other mental health concerns. Along with this was a corresponding rise in antidepressants, anti-anxiety medication and prescription sleep aids, known collectively as psychotropic drugs.³ 

“Behavioral health became a growing concern during the pandemic, but I was also struck by how much the general population became exposed to the conditions that injured workers have always gone through,” shared Walls. “Essentially, injured workers go through their own quarantine every time they are seriously injured.” 

What this adds up to is an increased focus on behavioral health care in workers’ compensation pharmacy. “Across the board, we saw an uptick in utilization for psychotropic drugs at the per patient level in 2020,” said Williams. “Effective pharmacy management also led to decreases in cost per days’ supply for major categories, including -7% for antidepressants.” 

“Workers’ comp payers need to start paying attention to behavioral care even if it goes against the traditional wisdom of not ‘buying the psych claim,’” said Walls. “Increasingly, we’re finding that chronic pain and mental health are highly interconnected and that ignoring the behavioral care component can lengthen the duration and cost of claims in the long term.” 

Expanding on the topic of chronic pain management, Walls and Williams stressed that the pandemic also brought new developments in the continuing fight against opioid misuse. We’ll be exploring this topic further in part two of this article, along with the latest developments in generic utilization. 

To learn more about these and other major drivers in the workers’ compensation pharmaceuticals sector, myMatrixx invites you to explore their 2020 Drug Trend Report.

 References 

1. https://www.cwci.org/press_release.html?id=790
2. https://www.ncsl.org/research/labor-and-employment/covid-19-workers-compensation.aspx
3. https://www.evernorth.com/articles/americas-state-of-mind-update-on-covid-19-and-mental-health

Courtesy of myMatrixx

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