Aging claims shape Optum 2021 pharmacy trends
As we look at our pharmacy trends from 2021, it’s safe to say that, while life is beginning to normalize from the COVID-19 pandemic, we still saw the impact of the pandemic when it comes to claim age, pharmacy transactions and medication utilization. So, before we jump in to our 2021 numbers, let’s start our review by looking back a few years – pre pandemic – to see the difference.
Data Methodology Analyses
• 2020-2021 paid workers’ compensation transactions
• More than 500,000 claims
• Over 4.7 million in-network prescriptions
• Captured through network enforcement solutions
• Excluded clients with less than a two-year history
The claim age comparison
In 2018 and 2019, the percentage of new, one-year old claims was over 50% of our claims volume. During that same time, 10+ year old claims were just over 16% of our total claims.
In comparison, in 2020 and 2021, the percentage of new, one-year old claims dropped to approximately 44% and 45% respectively, likely due to economic slowdowns and the increase in working from home both of which mean fewer in-person workplace injuries. The 10+ year old claims rose to just shy of 19% of total claims in 2020 and remained constant in 2021.
Percentage of claims
The percentage of scripts saw similar trends. In both 2018 and 2019, the percentage of scripts for new, one-year old claims was 20.2%. The percentage of scripts for 10+ year old claims was 44.1% and 44.9% respectively.
In 2020 and 2021, the percentage of scripts for new, one-year old claims dropped to less than 17% while the percentage of scripts for 10+ year old claims rose to over 47%.
Percentage of scripts
What these numbers show is that we are still dealing with a greater percentage of older claims without the influx of new claims from new injuries. This has shifted the influence of those older claims in the utilization trends that Optum Workers’ Compensation has monitored for many years. In 2021, the Optum book of business claim age increased 6.9% over the previous year again, due to the shift noted.
Older claims often have greater days of supply, higher-cost brand prescriptions and more medications in general as the claim ages. And, the longer a claim remains open and active with continuing and progressing treatments, the greater the likelihood for use of multiple medications, more drug interactions, increased treatment challenges from comorbid conditions, multiple prescribers and providers and a greater risk of potential complications. This proved true with our book of business, as, similar to last year, while our 10+ year-old claims made up 18.9% overall they accounted for 47.9% of prescriptions and 61.5% of overall costs.
| 2021 | Year 1 | Year 10+ |
|---|---|---|
| Percentage of claims by claim age | 44.9% | 18.9% |
| Percentage of scripts by claim age | 16.9% | 47.9% |
| Percentage of spend by claim age | 7.9% | 61.5% |
The impact of claim age
Related to 2021’s 6.9% increase in claim age, our pharmacy book of business showed the average cost per claim increased 5.3%, which is not surprising since the older claims also drove a higher average days of supply and slightly higher number of prescriptions.
2021 (difference from 2020)
| Average cost per claim | ↑5.3% |
| Average days of supply/rx | ↑3.7% |
| Change in product and claim mix | ↑0.2% |
| Scripts per claim | ↑1.3% |
61.5%
of overall costs came from 10+ year old claims
An interesting note from 2021, a year that has seen inflation for many other products, the Average Wholesale Price, or AWP in our book of business remained flat from the previous year and was the lowest in more than 7 years as noted in the following chart.
Seven-year historical AWP for overall, brand and generic medications
The strength of our clinical focus on opioids
The challenge of older claims was no match for the Optum clinical focus and our range of clinical programs. Our book of business’ average daily Morphine Equivalent Dose (MED) per claim dropped to 42.1 in this review year. Currently, well below the 50 MED recommendation for acute claims by the Centers for Disease Control.
Plus, for the ninth year in a row, our percentage of injured persons using opioids dropped 2.1% percentage points to 36.4% with the percent of spend at less than 20% overall.
2021
| Average MED Per Claim | 42.1 |
| Opioids as a % of total spend | 18.8% |
| % Of claims using opioids | 36.4% |
Optum Clinical programs deliver:
- Aggressive formulary management
- Strategic communication and education
- Targeted clinical oversight
- Informative analytics
- Timely regulatory actions
Looking forward to what’s next
For the second year, an increasing claim age has been a leading factor in our book of business. With reduced volumes of new claims coming in, older claims are one of the main drivers of costs and utilization. We will continue to monitor this trend to see if it is the new normal, especially with our current labor market and a changing remote and hybrid workforce.
Despite these dynamics, whole person care of the injured person is still our mission. We remain steadfast in helping each injured person return to the fullest recovery possible, by delivering the right treatments, at the right time, for the right duration. In 2022 and beyond, Optum will strive to achieve this with a focus on the following:
- Appropriate utilization of topical medications, patches and prepackaged topical compounds
- The coordination of ancillary and medical services with pharmacy treatments
- Behavioral health medications and treatments
- Continue clinical oversight and intervention on opioids
- Monitoring the impact of social determinants of health on managing claims
And as always, making a difference for your business and your injured persons.
Pharmacy trend Top 10s
Top 10 therapeutic classes ranked by total prescriptions
Top 10 therapeutic classes ranked by total spend
Top 10 medications by number of prescriptions
| 2021 Rank | 2020 Rank | Generic Name | Therapeutic Class |
|---|---|---|---|
| 1 | 1 | hydrocodone-acetaminophen | Analgesics - Opioid |
| 2 | 2 | gabapentin | Anticonvulsants |
| 3 | 3 | ibuprofen | Analgesics - Anti-Inflammatory |
| 4 | 4 | cyclobenzaprine | Musculoskeletal Therapy Agents |
| 5 | 5 | oxycodone-acetaminophen | Analgesics - Opioid |
| 6 | 6 | meloxicam | Analgesics - Anti-Inflammatory |
| 7 | 7 | tramadol | Analgesics - Opioid |
| 8 | 8 | pregabalin | Anticonvulsants |
| 9 | 9 | oxycodone | Analgesics - Opioid |
| 10 | 11 | duloxetine | Antidepressants |
Top 10 medications by spend
| 2021 Rank | 2020 Rank | Generic Name | Therapeutic Class |
|---|---|---|---|
| 1 | 1 | pregabalin | Anticonvulsants |
| 2 | 2 | oxycodone ER | Analgesics - Opioid |
| 3 | 3 | oxycodone-acetaminophen | Analgesics - Opioid |
| 4 | 4 | lidocaine | Dermatologicals |
| 5 | 5 | duloxetine | Antidepressants |
| 6 | 6 | celecoxib | Analgesics - Anti-Inflammatory |
| 7 | 7 | Gabapentin tablet | Anticonvulsants |
| 8 | 9 | Gabapentin capsule | Anticonvulsants |
| 9 | 10 | meloxicam | Analgesics - Anti-Inflammatory |
| 10 | 8 | hydrocodone-acetaminophen | Analgesics - Opioid |
Previous reports
2020 trends report
The year 2020 started with the buzz of a show called Tiger King. But, it was the COVID-19 pandemic that overshadowed them all and, for most of us, dramatically changed the way we live, play, and work.
2019 trends report
With 44 years of leading pharmacy care services, Optum workers’ comp continues to enhance our programs and services to answer the needs of our clients and industry.
2019 mid-year report
Our full mid-year report describes the importance of our Total Care Management Solution and how we anticipate a shift toward alternative pain control treatments.