Prescription Benchmarks, 2nd Edition: Trends and Interstate Comparisons

By Dongchun Wang, Te-Chun Liu

July 1, 2011 Related Topics: Fee Schedules, Physician Dispensing, Prescription Drugs and Opioids, Prescription Benchmarks

As drug costs for injured workers continue to rise across the country, policymakers and other stakeholders are searching for answers to control them.  To help you understand the key cost drivers, WCRI is pleased to provide you Prescription Benchmarks, 2nd Edition:  Trends and Interstate Comparisons.

This study, the second in an annual series of prescription benchmarks reports, compares the cost, price, and utilization of prescription drugs in 17 states.  For those engaged in workers’ compensation public policy debates, this study provides detailed comparisons that may be useful when debating such issues as:

  • Pharmacy fee schedules,
  • Physician prescribing patterns,
  • Medical cost drivers,
  • Laws that mandate the use of generics when available, and
  • Laws that regulate physician dispensing of prescription drugs at the office.

The study will also be useful for those seeking a more in depth understanding of prescription drug costs and utilization across states.

The 17 states included in this study are California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, Tennessee, Texas, and Wisconsin.     

The study is based on claims with more than seven days of lost time that had injuries occurring between October 2005 and September 2006 and prescriptions filled through March 2008 for interstate comparisons. Claims with an average 12-month experience were used for the trend analysis. The reader should be cautioned that the results based on an average 12- or 24-month experience understate the ultimate value of the metrics that depict quantities and costs.

The prescription benchmark measures include:

   Cost Metrics:

  • average payment for prescriptions per claim with prescriptions

   Price Metrics:

  • average price per pill and average price per prescription

   Utilization Metrics:

  • average number of pills per claim with prescriptions
  • average number of prescriptions per claim with prescriptions
  • average number of visits to a dispensing point (e.g., pharmacy of physician's office)
  • average number of prescriptions filled per visit
  • average number of pills per prescription

These metrics were constructed for all prescriptions, by dispensing point (a physician’s office or a pharmacy), and for common drugs.

Prescription Benchmarks, 2nd Edition: Trends and Interstate Comparisons. Dongchun Wang and Te-Chun Liu. July 2011. WC-11-33.

Copyright: WCRI

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