Changes in the Pharmaceutical Industry

A recent study performed by the Workers’ Compensation Research Institute (WCRI) found that in 26 states, the frequency of physicians dispensing prescriptions and drug prices dropped in all the states that had recently enacted laws to reform pharmaceutical industry practices. Despite this drop, Workers’ Compensation providers still face high drug prices due to the various methods drug companies employ to keep prices up. These methods include altering drug formulations and drug strengths to get around legal restrictions.

The study examined data from 2011 to 2014, when many of the states studied instituted their reforms. It found that in many of the states with reforms, there was a significant drop in the cost share of all physician-dispensed prescription drugs. It also found that opioid prescriptions in various states dropped, which could indicate that many of the opioids prescribed were not necessary.

Reforms Used to Combat Rising Drug Prices

Twenty-two states passed reforms within the past decade to manage drug price increases. Some of these reforms are focused on controlling drug prices and use of repackaged drugs by instituting caps on their wholesale prices, and others are limits on specific drugs and their use for a specified period. Repackaging drugs was a big part of suppliers’ strategies to keep prices up. A few of the reformulated drugs cited in the study were:

• 150 mg extended release Tramadol HCL (Ultram)
• Lidocaine-menthol

Potential Solutions for Workers’ Compensation Providers

According to Joseph Paduda, principal of Workers’ Compensation managed care consulting firm, Health Strategies Associates, there are a few ways to keep drug prices affordable for Workers’ Compensation providers. One of them is to stop drug manufacturers from repackaging drugs with slightly different formulations or strengths as new products. Another strategy is to put reimbursement limits on scripts or per script ingredient, which would limit the number of ingredients permitted in a specific script, or simply limit how expensive it can become. This second strategy is aimed at reducing the use of drug compounding as a loophole to the reforms in place.

Drug compounding is the practice of blending drug ingredients together to create custom medication. It is used to create medications for patients with specific medical needs, like the need for a different dose than the typical dose, or a patient who cannot swallow pills. Though compounding drugs constitutes less than one percent of the prescriptions dispensed in the United States, they can become quite expensive and put financial pressure on Workers’ Compensation providers. Compounded drugs are also subject to far less testing and industry oversight than traditionally manufactured drugs.

Cherry Hill Workers’ Compensation Lawyers at DiTomaso Law Help Injured Workers Access the Benefits They Deserve

Prescription drug coverage is one of the benefits an injured worker can access through a Workers’ Compensation claim. Others include coverage for surgery and other medical treatments, as well as compensation for lost wages. To learn more about Workers’ Compensation and your right to seek benefits, fill out our online form or call 856-414-0010 to set up your initial consultation with a Cherry Hill Workers’ Compensation lawyer at DiTomaso Law. Our office is in Cherry Hill, New Jersey, and we serve clients throughout the state.