The good news is that drug cost inflation in workers' compensation has moderated considerably in recent years. The bad news is that this moderation is not industry-wide, but rather favors those payers who have worked long and hard to rein in drug costs. The reward has been considerable: the best performers – those who focused on managing utilization – actually saw their drug costs decline over the past year.

For five consecutive years, Health Strategy Associates, LLC has conducted an annual survey of executives and senior management at workers' compensation payers on prescription drug management. During that time, we have seen pharmacy costs grow even faster than medical expenses, and they now account for 14.5 percent of workers' compensation medical expenses (more than $4 billion).

The survey draws responses from decision-makers and operations staff at carriers, TPAs, large employers, and managed-care firms. With 2007 drug expenses ranging from $1 million to $147 million, respondents' total prescription expenditure amounted to $777 million, or 18.5 percent of total estimated workers' compensation drug spending.

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