The Hartford, in an announcement yesterday, said it has contracted with a pharmacy benefits management program, Tmesys, a service of the PMSI division of PharMerica, as one of a number of steps to put a halter on prescription costs. "We think we are well on the way" to reducing costs, said Mr. Martino.

In examining its drug costs, the company did a ranking of 25 medications. According to Mr. Martino the most money the company spent on prescriptions was for the drug Oxycontin, followed by Celebrex and Vioxx.

Mr. Martino noted that, in the past, the painkillers Relafen and Daypro were among the top 10 on the list. They cost about $1.50 per dose, he said. Now, he advised Relafen is 22^nd on the list and Daypro has dropped off entirely. Celebrex and the other drugs that have taken their place cost from $2.50 to $3.00 a dose, he said.

The volume of Vioxx prescriptions, according to The Hartford, jumped 908 percent last year compared with 1999. The drug is produced by Merck for arthritis and menstrual pain.

Zanaflex, an Elan Pharmaceuticals drug for muscle spasms was found to have gone from 25 to 14 on the list--with volume increasing 567 percent.

Mr. Martino said that The Hartford, by written premium the eighth largest workers' comp writer in the country, typically finds pain medications prescribed for back, knee and shoulder problems.

The company's analysis of workers' compensation claims clients' prescription medicine costs were unveiled at the 40^th Annual Risk and Insurance Management Society meeting in New Orleans.

Insurer Hartford and Specialty Risk Services, which is a third party administrator, said that high prescription costs should be addressed on four fronts:

? Analyze data to understand trends and improve outcomes.

? Inform injured workers and care service providers.

? Enhance pharmacy utilization management.

? Fight prescription fraud and abuse.

According to The Hartford, its analysis found that the higher-priced drugs were being prescribed for conditions successfully treated by other medications.

Providing information to injured workers and physicians about alternatives and implementing a pharmacy benefit management program, Mr. Martino said "are both crucial in helping to control workers' compensation costs."

The Hartford said its pharmacy benefits management program offers its workers' compensation customers access to more than 90 percent of the nation's retail pharmacies.

According to the company, besides saving workers' compensation clients money through retail pharmacy discounts and generic drug substitution when appropriate and permissible, a pharmacy management program can flag potential side effects or other dangers and bring these to the attention of the pharmacist or care providers.

As an example, the insurer said, a painkiller may cause stomach problems or sleeplessness, requiring additional medication. Other medicines may be addictive and should only be used for a short period.

A pharmacy benefits management program, the company said, could uncover unusual usage patterns, which may indicate fraud.

The company said other solutions for reducing cost include introduction of new state legislation to increase generic drug use and implementation of more utilization controls.

According to Mr. Martino, prescription regiments are sometimes more effective when coupled with other treatment modalities such as physical therapy.

He noted that an increase in prescription drug volume rather than price has been a general market trend.