Work Comp Prescription Drug Costs in Texas 30% Higher than Median

The payment per claim for prescription drugs used to treat injured workers in Texas was nearly one-third higher than in most study states, according to a new study by the Workers Compensation Research Institute (WCRI).

The 16-state study by the Cambridge, Mass.-based WCRI found that the average payment per claim for prescription drugs in the Texas workers’ compensation system was $536 — 30 percent higher than the median of the study states.

The main reason for the higher prescription costs in Texas was the higher utilization of prescription drugs — workers received more prescriptions for more pills per claim.

The WCRI study, Prescription Benchmarks for Texas, found that the average number of pills per claim with prescriptions in Texas was 41 percent higher than the 16-state median. At the same time, the average number of prescriptions per workers’ compensation claim was 34 percent higher.

The study reported that while injured Texas workers received the same types of medications as workers did in the other states, physicians in Texas prescribed more frequently for muscle relaxants and anti-infectives. For example, Carisoprodol (muscle relaxant) was received by 8 percent of the injured workers in Texas (and 12 percent in neighboring Louisiana). This is in contrast with 2 percent to 4 percent of claims in most other states, except in a few states where physician dispensing was a significant cost driver. This may be due to regional differences in the training of physicians or practice norms, according to WCRI.

The study noted that the average price per pill paid to pharmacies in Texas was similar to the median of the 16 study states. However, physicians in Texas use brand name medications for 20 percent of all prescriptions, compared with 15 percent in the median state. This occurred when generic equivalents were available, and more often, when generic equivalents were not available, but generic alternatives were available.

The study pointed out that unlike many states studied, physicians in Texas (as well as Massachusetts and New York) were generally not permitted to dispense prescription drugs. Physician dispensing often can add costs because physicians were often paid more than pharmacies for the same prescription, said WCRI.

Source: WCRI