WCRI Reports Payment Per Claim For Drugs Prescribed To MA Injured Workers Was Lower Than Study Median

The 16-state study by the Cambridge, MA-based WCRI found that the average payment per claim for prescription drugs in the Massachusetts workers' compensation system was $289—30 percent lower than the median of the study states.

The main reasons for the lower prescription costs in Massachusetts include lower prices paid to pharmacies due to a lower pharmacy fee schedule, more frequent use of less expensive generic drugs, and a ban on physicians dispensing medications directly to their patients.

The WCRI study, Prescription Benchmarks for Massachusetts, found that the average prices paid to pharmacies for common drugs were lower than the median study state, largely due to the state's lower pharmacy fee schedule. The Massachusetts pharmacy fee schedule was based on the Wholesale Acquisition Cost, which is much lower than the Average Wholesale Price that is used in many states as a reference price for pharmacy fee schedules.

For example, the price paid for the painkiller Percocet^®, a drug prescribed in 41 percent of claims with prescriptions in Massachusetts, was 22 percent lower than the median of the 16 states.

Less frequent prescriptions for brand name drugs to treat injured workers in the state also contributed to the lower average prices in Massachusetts. Physicians in Massachusetts used brand name medications for only 12 percent of all prescriptions, compared with 15 percent in the median state, according to the study.

The study also found that the utilization of prescription drugs in Massachusetts was lower because physicians wrote and workers filled fewer prescriptions. The average number of prescriptions per claim in Massachusetts was 17 percent lower than the median state while the average number of pills per claim was 14 percent lower.

Unlike many states in the study, Massachusetts was also one of three states (New York, and Texas) where physician dispensing was not allowed. In several states where physician dispensing was common, physician-dispensers were often paid higher than pharmacies for the same prescription.

The WCRI study is the first in an annual series that benchmarks the cost, price and utilization of pharmaceuticals in workers' compensation.

The Workers Compensation Research Institute is a nonpartisan, not-for-profit membership organization conducting public policy research on workers' compensation, healthcare and disability issues.  Its members include employers, insurers, insurance regulators and state administrative agencies in the U.S., Canada, Australia and New Zealand as well as several state labor organizations.

Source: Workers Compensation Research Institute 

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