Press Release
CWCI Examines the Utilization & Reimbursement of Schedule II Drugs in California WC
In a study released earlier this month, the California Workers’ Compensation Institute found that both the average number of prescriptions and average pharmaceutical payments per California workers’ compensation claim have risen sharply since 2002, with the most notable increases occurring between 2005 and 2008 – after the adoption of workers’ compensation medical reforms and the pharmacy fee schedule in 2004. One of the key cost drivers identified in that study was a post-reform surge in the use of “Schedule II” drugs – controlled substances that the federal government says not only have accepted medical uses, but very high potential for abuse or addiction.
In a follow up to that report, the Institute has issued a Research Spotlight Report that shows the Schedule II prescription and payment distributions within California workers’ compensation from 2005 to 2008 — prior to the July 2009 adoption of chronic pain management guidelines in the Medical Treatment Utilization Schedule, but after the enactment of workers’ compensation medical reforms and adoption of the pharmacy fee schedule in 2004. The analysis uses data from CWCI’s Industry Claims Information System (ICIS) database to measure the extent to which various categories of Schedule II drugs have contributed to the recent growth in the volume and cost of these medications in California workers’ compensation, focusing on three key questions:
• Which types of Schedule II drugs are most heavily used to treat injured workers in California;
• Which types of Schedule II drugs have the greatest impact on pharmaceutical costs; and
• Has there been a significant shift in the mix of Schedule II prescriptions or in the distribution of payments for these drugs in California workers’ compensation as the overall utilization and cost of these medications has increased?
A copy of the CWCI Research Spotlight Report, “Schedule II Prescription & Payment Distributions in California Workers’ Compensation: 2005 – 2008” is posted under Research on the Institute’s website, which can be accessed by clicking here.