Narcotics in Workers · PDF filehare Of Dru 0% 5% Narcotics 10% 123456789 1011121314 Relative Service Year ... Microsoft PowerPoint - RBS_Workshop-Narcotics.pptx Author: COJVR Created

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

© Copyright 2009 NCCI Holdings, Inc. All Rights Reserved. 1

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


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


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


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


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



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



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


Low Cost Medium Cost High Cost


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


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


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


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%


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%


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%


Top Paid Narcotics in 2007 With HYDROCODONE as Active Ingredientg


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%


Top Paid Narcotics in 2007 WithFENTANYL as Active Ingredientg


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%


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


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


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


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


Documents

Narcotics in Workers · PDF filehare Of Dru 0% 5% Narcotics 10% 123456789 1011121314 Relative Service Year ... Microsoft PowerPoint - RBS_Workshop-Narcotics.pptx Author: COJVR Created