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WCIRB Releases Aggregate Medical Payment Trends Update

The WCIRB has released the California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment information from 2015 to 2017. The WCIRB analysis is based on medical payment data representing 92% of the California workers’ compensation insurance market.

Among the key findings of the report are:

  • There were sharp declines in the average paid per transaction for pharmaceuticals (24%), pharmacies (28%) and pharmacists (27%) since 2015. This continues to be a result of reductions in the prescribing of controlled substances, reduced physician office dispensing, implementation of the Federal Upper Limits on prescription drug prices, as well as the continued shift from brand to generic drugs. (These reductions pre-date the implementation of the new drug formulary implemented in January 2018 pursuant to Assembly Bill No. 1124). 
  • There were sharp decreases in the share of workers’ compensation claims with any opioid prescription from 18.2% in 2015 to 11.6% in 2017. The medical payments on the claims with at least one opioid prescription were, on average, more than three times higher than those on the claims without opioid prescriptions.
  • There was a significant change in the mix of Medical-Legal (ML) services in 2017. The share of ML104 (the most comprehensive and expensive service) transactions declined by 22.7%, while that for ML102 (the most basic ML evaluation) increased by 42.6%. This resulted in an 8% decline in the average cost of a medical-legal report in 2017 following a number of years of increases.

The full report is available in the Research section of the WCIRB website and from the link below:

California Workers’ Compensation Aggregate Medical Payment Trends – Updated through Calendar Year 2017

November 6, 2018