Prescription drug costs in workers’ compensation claims are rising, making it necessary for claims professionals to carefully evaluate this exposure and mitigate costs when possible. Staying up to date on current pharmacy trends, including new medications introduced to the market and generic equivalents, is one piece of the equation to mitigating costs.
Every brand medication has a patent life and once the patent expires, generic equivalents will be introduced into the market at a lower cost. Although there is no set brand versus generic price differential upon generic entry, there is a large cost savings that accompanies the generic release. The gap between brand and generic pricing widens as brand name medications continue to have annual (or quicker) increases to the AWP (average wholesale price), whereas the generic formulations do not generally experience annual inflation. Some generic equivalents can launch at reductions of 70% from the brand medication price, which is a significant decrease.
Recently, there have been several new medications and generic equivalents approved by the FDA that will have an impact on workers’ compensation claims. Gralise (Gabapentin) is a new once-a-day dosing of Gabapentin which is FDA approved for post herpetic neuralgia pain. It is to be taken once per day with the evening meal, which should lead to better patient compliance along with a better therapeutic outcome. Gralise has been shown to produce fewer side effects than Lyrica and Neurontin (Gabapentin) and will more than likely gain in popularity among prescribers for its use in treating neuropathy and radiculopathy in chronic pain patients. At this time, there is no pricing available for Gralise.
For chronic pain management, a long acting (extended release) pain medication formulation is preferred over its short acting counterpart. Both Nucynta ER (Tapentadol) and Tramadol ER 300mg- (generic Ultram ER 300mg), which are newly approved medications, fall into this category. Nucynta ER and Tramadol ER are both pain medications approved by the FDA for treatment of moderate to severe pain requiring continuous, around the clock analgesia unlike their immediate release formulations, which are taken on an as needed basis. The average cost of Nucynta ER 50mg twice a day for a month supply is $177.60 while Nucynta 50mg (immediate release) taken once every 4-6 hrs is $277.20; therefore, not only should the extended release formulation provide overall better pain control, but it would also be more cost effective.
According to PMSI’s Drug Trends Report, Ultram ER is one of the top 20 brand medications prescribed in workers’ compensation. Ultram ER and its generic Tramadol ER are dosed at once a day. The average cost of brand Ultram ER 300mg is $279.90 for a one month supply while the generic Tramadol ER 300mg averages $162.30 per month. Additionally, Tramadol ER is also less expensive than its immediate release formulation, which can be prescribed up to 8 tablets per day, at an average monthly cost of $189.60.
The above noted pricing differences creates an incentive to address the potential use of generic and/or long acting medications with the treating physician when an injured individual is being prescribed the brand or short acting medications, if a cost savings can be realized. Sleep aids are commonly prescribed medications for workers’ compensation injuries when there are significant pain complaints and insomnia is present. According to PMSI’s Drug Trends Report, Lunesta was noted to be the second most prescribed medication for insomnia in workers’ compensation. Generic Lunesta (Eszopiclone) has now been FDA approved for the treatment of insomnia. No release date or pricing for the generic has been released by its manufacturer as of today, but the approval of the generic formulation will likely impact medication transaction costs within the workers’ compensation community.
Keeping up to date on new drugs as well as generic formulations as they are approved by the FDA will help mitigate the rising cost of claims as well as provide for the potential of an overall better therapeutic response for the injured worker.