Astronomical Cost per Claim for Prescription Drugs Leave North Carolina Workers’ Compensation Experts Scratching Their Heads

May 20, 2010, by Michael A. DeMayo

The Workers’ Compensation Research Institute (WCRI) released a study at the end of April suggesting that North Carolina worker’s compensation claimants may be paying much more per claim for prescription drugs than claimants do in other states. The Cambridge-based Institute found that the NC rate was 14% higher than other states. On average, each claim cost $467. WCRI analysts suggested that the hike in prescription costs might be due to certain kinds of drugs prescribed, such as the muscle relaxants Metaxalone and Cyclobenzaprine. The study found that NC rates of consumption for these two muscle reluctants was nearly 20% higher than the average rate for the 16 states studied.

WCRI analysts had theories to account for the higher cost. For one, in North Carolina, physicians do a lot of direct prescribing of medications (instead of urging patients to get drugs filled at pharmacies). This may have had a cost impact, since physician dispensation typically results in slightly elevated costs.

Another theory is that the price per pill of certain medications was simply higher for several medications, such as the aforementioned Metaxalone and Cyclobenzaprine.

What might be the policy implications for North Carolina worker’s compensation from this latest WCRI Study?

Assuming the data are correct, policymakers may want to consider changing the system to encourage physicians to dispense fewer medications directly and to leave that job to the pharmacies. Policymakers might also examine whether market incentives could depress prices. They may also consult pharmacists and physicians directly for suggestions.

If you or a loved one is on prescription drugs as a result of a North Carolina workers’ compensation claim, it may help to take the time to consult with a respected North Carolina Workers compensation lawyer regarding your options. Patients who understand the rules and protocols of the NC workers’ comp system and who follow these guidelines strictly tend to do better over the long term in terms of getting rehabilitated and regaining their financial footing.

More Web Resources:

Workers’ Compensation Research Institute (WCRI)

Full story on how/why NC rate was 14% higher than other states

 
 

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