Narcotics in Workers CompensationNarcotics in Workers Compensation
Barry Lipton, FCAS, MAAABarry Lipton, FCAS, MAAAPractice Leader and Senior ActuaryPractice Leader and Senior ActuaryMay 8, 2009May 8, 2009O l d Fl idO l d Fl idOrlando, FloridaOrlando, Florida
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Topics of Interest
• Extent of narcotics use in workers compensation
• Types of narcotics used
h h • Injury groups with the most narcotics use
• Treatment expenses related to use of narcoticsTreatment expenses related to use of narcotics
• Persistence of narcotics use
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Study Design
• Data is based on a nationwide sample
• Data includes claims from 1994 to 2007 and services from 1996 to 2007
• Narcotics are those listed in: I t ti l N ti C t l B dInternational Narcotics Control BoardList of Narcotic Drugs Under International Control, Yellow List, 47th editionControl, Yellow List, 47th editionDecember 2007
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Early Narcotics Use Is Increasing
14 0%
16.0%Narcotics Use 12 to 36 Months After Injury
10.0%
12.0%
14.0%
cal C
laim
s co
tics
Narcotics Use Within 36 Months of Injury
6.0%
8.0%
age
of M
edic
ceiv
ing
Nar
c
0 0%
2.0%
4.0%
Perc
enta
Rec
0.0%1999 2000 2001 2002 2003 2004
Injury Year
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Narcotics Share of Drug Prescriptions Is Persistent as Claims Ageg
35%
40%
ons
25%
30%
35%
g Pr
escr
ipti
15%
20%
Shar
e O
f Dru
0%
5%
10%
Nar
cotic
s S
0%1 2 3 4 5 6 7 8 9 10 11 12 13 14
Relative Service Year
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Narcotics Share of Drug CostsIncreases as Claims Ageg
40%
45%
llars
30%
35%
40%
aid
Dru
g D
o
15%
20%
25%
Shar
e O
f Pa
0%
5%
10%
Nar
cotic
s
0%1 2 3 4 5 6 7 8 9 10 11 12 13 14
Relative Service Year
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Average Narcotics Prescription Cost Increases as Claims Ageg
$250
$200
$250
riptio
n C
ost
$100
$150
otic
s Pr
escr
$50
vera
ge N
arco
$01 2 3 4 5 6 7 8 9 10 11 12
Av
Relative Service Year
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High-Cost Narcotics Are a Greater Portion of Narcotics as Claims Ageg
90%100%
n
50%60%70%80%
resc
riptio
nbu
tion
20%30%40%50%
arco
tics
PD
istr
i b
0%10%20%
1 2 3 4 5 6 7 8 9 10 11 12
N
Relative Service Year
Low Cost Medium Cost High Cost
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WC Narcotics Costs per Medical Claim
ORMT
MN
IDNH
NE
WI
IN
ID
UT IL
MIIA
CA
MA
CTPA
DEKS
OK
KY
TN
CO
AR SC
VA
NC
AZ
MOCA
MDDE
Below Average
Average
Above AverageLA
MS
FL
GA
TXAL
Injury Years 1999 through 2003Relative Service Years 1 through 5
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Narcotics Share of Drug Dollars Has Been Stable Over Time
30%
rs
20%
25%
f Dru
g D
olla
15%
ics
Shar
e O
f
5%
10%
Nar
coti
1999 2000 2001 2002 2003 2004 2005 2006 2007
Service YearRelative Service Years 1 through 6
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Average Narcotics Costs per Claim Recently Stable
35%40%
Price Utilization Total Cost per Claim
y
20%25%30%
e G
row
th
5%10%15%
Perc
enta
ge
-10%-5%0%
1999 2000 2001 2002 2003 2004 2005 20061999-2000
2000-2001
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007 p
Service Yearp Preliminary Relative Service Years 1 through 6
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Most Narcotics Dollars Paid Are for the Active Ingredient OXYCODONEg
PROPOXYPHENE3.1%
OXYMORPHONE1.9%
CODEINE0.9% Other Narcotics
2.1%
MORPHINE9.1%
OXYCODONE37.4%
FENTANYL CITRATE10.8%
HYDROCODONE23.0%
FENTANYL11.8%
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Most Narcotics Prescriptions Are for the Active Ingredient HYDROCODONEg
CODEINE3.1%
FENTANYL2.4%
METHADONE1.4%
Other Narcotics2 4%
PROPOXYPHENE
MORPHINE3.3%
2.4%
HYDROCODONE
PROPOXYPHENE8.6%
57.6%OXYCODONE21.3%
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Top Paid Narcotics in 2007 With OXYCODONE as Active Ingredientg
Drug Name % Paid % ScriptsPaidRank
Script Rank
OXYCODONE HCL 12.2% 5.7% 2 4OXYCONTIN® 11.9% 1.8% 3 6OXYCODONE W/ACETAMINOPHEN 7.0% 10.6% 5 2PERCOCET® 3.5% 0.9% 10 11ENDOCET® 2.4% 1.8% 12 7ROXICODONE® 0.2% 0.1% 31 38ROXICET® 0.1% 0.2% 39 22MAGNACET® 0 1% 0 0% 43 55MAGNACET® 0.1% 0.0% 43 55COMBUNOX® 0.1% 0.0% 47 46ETH‐OXYDOSE® 0.1% 0.0% 49 56All Others 0 1% 0 1%All Others 0.1% 0.1%Subtotal 37.4% 21.3%
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Top Paid Narcotics in 2007 With HYDROCODONE as Active Ingredientg
Drug Name % Paid % ScriptsPaidRank
Script Rank
HYDROCODONE/ACETAMINOPHEN 19.9% 55.2% 1 1HYDROCODONE BIT‐IBUPROFEN 0.6% 0.8% 18 15NORCO® 0.6% 0.3% 19 20THERACODOPHEN‐650® 0.5% 0.2% 20 27LORTAB® 0 4% 0 4% 23 18LORTAB 0.4% 0.4% 23 18VICODIN ES® 0.2% 0.3% 28 21VICODIN® 0.1% 0.2% 32 24HYDROCODONE BITARTRATE 0.1% 0.0% 35 43
/LORCET 10/650® 0.1% 0.0% 37 44XODOL 10/300® 0.1% 0.0% 40 45THERACODOPHEN‐LOW‐90® 0.1% 0.0% 41 54VICODIN HP® 0.1% 0.0% 45 50VICODIN HP 0.1% 0.0% 45 50VICOPROFEN® 0.1% 0.0% 48 51All Others 0.1% 0.1%Subtotal 23.0% 57.6%
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Top Paid Narcotics in 2007 WithFENTANYL as Active Ingredientg
Drug Name % Paid % ScriptsPaidRank
Script Rank
FENTANYL 7.1% 1.7% 4 8DURAGESIC® 4.7% 0.7% 7 16FENTANYL 11.8% 2.4%
ACTIQ® 4.9% 0.1% 6 36FENTANYL CITRATE 4.2% 0.2% 8 26FENTORA® 1.7% 0.1% 15 37All Others 0.0% 0.0%FENTANYL CITRATE 10.8% 0.3%
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Top ICD9 Diagnosis Codes in 2007
33.5%35%
40%
tion 722 - Intervertebral disc disorders
724 - Other and unspecified disorders of back23 O h di d f i l i
23.3%
33.5%
25%
30%
35%
e C
ontr
ibut 723 - Other disorders of cervical region
726 - Peripheral enthesopathies and allied syndromes840 - Sprains and strains of shoulder and upper arm959 - Injury other and unspecified
8.7% 7 1%10.7% 9.0%10%
15%
20%
cotic
Sha
re
8.7% 7.1%5.4% 4.9% 4.1%3.4% 2.7% 4.4%
0%
5%
10%
ICD
9 N
arc
722 724 723 726 840 959ICD9 Codes
Prescriptions Dollars
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Claims With Heavy Narcotics UseAre More Likely to Have Drug Abuse y g
Treatments18%20%
Dependent and Nondependent
12%14%16%18%
h Tr
eatm
ent
Abu
se
Only Dependent Drug Abuse
Only Nondependent Drug Abuse
Either Dependent or Nondependent
6%8%
10%12%
Cla
ims
With
for D
rug p p
0%2%4%6%C
0%>0 1-10 11-30 31-50 >50
Number of Narcotics on ClaimInjury Years 1997 through 2001Relative Service Years 1 through 7
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Persistence of Narcotics UseClaimants Receiving Narcotics Betweeng
12 and 24 Months After Injury
90%
100%
60%
70%
80%
Cla
ims
cotic
s
36.2%40%
50%
60%
cent
age
of C
ceiv
ing
Nar
c
13.7%8.8% 5.8% 4.1% 3.3%10%
20%
30%
Perc
Rec
0%1 2 3 4 5 6 7 8 9 10 11 12 13
Years of Continuous Narcotic Usage
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Summary
• As claims age, the narcotics share of total drug costs increases due to a shift toward more expensive narcotics
• The growth in narcotics costs per claim was much greater The growth in narcotics costs per claim was much greater between 1999 and 2004 than more recent years
• A majority of all narcotics prescribed contain either O d H d dOxycodone or Hydrocodone
• Narcotics are prescribed for back or neck injuries more often than for other injuriesj
• Full study will appear on ncci.com
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