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Pharmaceutical Descriptive Analysis

Pharmaceutical Descriptive Analysis. Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group July 2007. Overview. Data and Methods Distribution of System Costs Utilization and Costs by Prescription Year: Injury Year Injury Type Therapeutic Classification Group

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Pharmaceutical Descriptive Analysis

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  1. Pharmaceutical Descriptive Analysis Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group July 2007

  2. Overview • Data and Methods • Distribution of System Costs • Utilization and Costs by Prescription Year: • Injury Year • Injury Type • Therapeutic Classification Group • Therapeutic Classification Sub-Class • Payment Denial Patterns • Generic Substitution Patterns • Summary of Key Results • Next Step

  3. Data and Methods • Data sources: • DWC 837 Medical data • Medi-Span Master Drug Database (Classification Groups) • ECS 2000-2004 Medical/Hospital Bills (To identify Injury Types) • Data Parameters: • Injury Years 1991 – 2006 • Prescription Years 2005 and 2006 • Prescriptions for 90 Days or less (99.8% of all data) • Dropped prescriptions with denials for Duplicate, Entitlement, and Compensability issues

  4. Data and Methods, Continued • Measures: • Prescriptions: Number of Billing Lines • Units = Number of Days • Payments • Charges • Injured Employees (Defined by number of unique SSN/Injury Date) • Injury Types (Standard ICD9 classifications used by REG) • Data Issues: • Injury Types unidentifiable for 30% of prescription bills • The number of Drug Days varied widely

  5. System Measures

  6. Payments in the Texas Workers’ Compensation SystemPrescription Years 2005 - 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: Percent of Total Payments may not add up to 100% because of rounding. Note 2: The California Workers’ Compensation Institute (CWCI) estimates that in 2005 California’s Pharmacy cost was 7 percent of that state’s medical costs.

  7. Percent of Medical Paymentsin the Texas Workers’ Compensation Systemby Medical Type, Prescription Years 2005-2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: Percent of Total Payments may not add up to 100% because of rounding.

  8. Payment to Charge RatioTexas Workers’ Compensation SystemPrescription Years 2005 - 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  9. Injured Employees Receiving Prescriptions in the Texas Workers’ Compensation SystemPrescription Years 2005 - 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  10. Pharmaceuticals in The Texas Workers’ Compensation SystemUtilization and Costs

  11. Distribution of Pharmaceutical Utilization and Payments by Injury Year Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: Percent of Total Payments may not add up to 100% because of rounding.

  12. Pharmaceutical Utilization and Paymentsby Injury YearPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  13. Average Pharmaceutical Utilization and Payments Per Injured Employee by Injury Year, Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  14. Pharmaceutical Utilization and Paymentsby Injury YearPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  15. Distribution of Pharmaceutical Utilization and Payments by Injury Type, Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: Percents may not add up to 100% because of rounding. Note 2: More than 30% of injured employees with unknown injury types were injured between 1991 and 1995

  16. Pharmaceutical Utilization and Paymentsby Injury TypePrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note *: More than 30% of injured employees with unknown injury types were injured between 1991 and 1995

  17. Distribution of Pharmaceutical Utilization and Payments Per Injured Employee by Injury Type, Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: More than 30% of injured employees with unknown injury types were injured between 1991 and 1995

  18. Pharmaceutical Utilization and Paymentsby Selected Injury TypesPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note *: More than 30% of injured employees with unknown injury types were injured between 1991 and 1995

  19. Pharmaceutical Utilization and Payments by Therapeutic Classification GroupPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: The 7 selected groups are the most frequently utilized groups (79% of all prescriptions) in the Texas WC system. The Other Groups are the remaining 82 less frequently utilized groups (21% of all prescriptions). Note**: Total number of Injured Employees include duplicates since each employee could receive prescriptions from multiple therapeutic classification groups.

  20. Cumulative Distribution of Pharmaceutical Prescriptions by Therapeutic Classification GroupPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: Texas WC prescriptions in 2006 were for 6,001 unique Drug Names from 626 Subclasses. The Subclasses fall into 89 distinct Therapeutic Classification Groups as defined by the Medi-Span classification system

  21. Most Frequently Dispensed Prescriptions by Therapeutic Classification Subclass*Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: These 40 subclasses represent all the subclasses found in the 7 most frequently utilized Therapeutic Classification Groups

  22. Most Frequently Dispensed Prescriptions, Continuedby Therapeutic Classification Subclass*Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: These 40 subclasses represent all the subclasses found in the 7 most frequently utilized Therapeutic Classification Groups

  23. Most Frequently Dispensed Prescriptions, Continued by Therapeutic Classification Subclass*Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: These 40 subclasses represent all the subclasses found in the 7 most frequently utilized Therapeutic Classification Groups

  24. Most Frequently Dispensed Prescriptions, Continued by Therapeutic Classification Subclass*Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: The first 40 subclasses represent all the subclasses found in the 7 most frequently utilized Therapeutic Classification Groups

  25. Five Most Frequently Utilized Drug Subclasses *Total Number of PrescriptionsPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: These 5 subclasses represent 56 percent of all the drugs dispensed in the Texas workers compensation system

  26. Pharmaceuticals in The Texas Workers’ Compensation SystemPrescription Denials

  27. Most Frequently Denied Prescriptionsby Therapeutic Classification GroupsPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: Total number of injured employees include duplicates since each employee could receive prescriptions from multiple therapeutic classification groups.

  28. Approved and Denied Prescriptionsby Therapeutic Classification GroupsPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  29. Five Most Frequently Denied Drug Subclasses Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note*: The Other Subclasses group represents 586 subclasses system

  30. Percent of Denied Prescriptionsby Denial CodesPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  31. Percent of Denied Prescriptionsby Injury TypesPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  32. Pharmaceuticals in The Texas Workers’ Compensation SystemGeneric Substitution

  33. Generic Substitution Rate Where Generics were available *Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note* : Approximately 85,000 prescriptions (5 percent) did not have generics available

  34. Generics and Brand Name Frequencies by Therapeutic Classification GroupsPrescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  35. Generic Substitution RatesTherapeutic Classification Groups Prescription Year 2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

  36. Summary • Pharmaceutical costs comprise 14 percent of all workers’ compensation costs in Texas • Seventy two percent of all pharmaceutical charges are paid (compared to 60 percent for dental, 39 percent for professional, and 29 percent for hospital bills) • Approximately 48 percent of all injured workers receiving medical services in 2006 also received prescribed drugs for their injuries • Injuries sustained between the years 1991 and 2000 (13%) account for a disproportionate share of pharmaceutical costs in 2006(46%) • Among the identifiable injury types, Low Back soft tissue injuries account for the highest number of prescriptions

  37. Summary, Continued • A total of 7 of the 89 Therapeutic Classification Groups (40 of the 626 Subclasses) account for 79 percent of all the prescriptions filled in 2006 • Approximately 10% of prescriptions and 28% of charges are denied • Approximately 11% of Hypnotics prescriptions are substituted to the generic alternative

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