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Industry Insights

Paduda: The Latest on Workers' Comp Pharmacy

  • National

We are finishing up our annual survey of pharmacy benefits management in workers’ comp. Here are three findings from the 15 we’ve done so far.

  • Joe Paduda

    Joe Paduda

    Sixty percent of respondents are reporting an increase in overall drug spend, with reasons varying from more claims to an uptick in catastrophic cases to jurisdictional impacts.

While we’re a long way from done and more respondent data is coming in, if the trend continues, this would be the second year of “non-decrease” in spend, signaling that the years-long drop in spend has stopped — and may have reversed.

  • Conversely, 80% of respondents are reporting lower opioid spend year over year.

If other respondents’ data is consistent, this marks the seventh consecutive year of a decrease, wonderful news, indeed, as patients and providers choose safer — and often more effective — solutions to pain.

  • Most respondents see a future for artificial intelligence in the PBM world, but the emphasis is definitely on the future.

There seems to be significant hesitation around implementing AI-based tools at this point. Ultimately, respondents see a range of “futures,” ranging from 100% automation of the entire process driven by AI to those who see AI focusing largely on early trend identification and clinical management improvements.

Public versions of our annual survey report are available for download here at no cost and no registration. Note that respondents get a much more detailed version of the report. 

Thanks to HSA’s Jay Stith and Helen Knight of CompPharma for their work on this year’s survey.

Joseph Paduda is the principal of Health Strategy Associates, a consulting firm focused on improving medical management programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.

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