Drug Benefit Program

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Introduction

The WSIB is committed to delivering what matters to the people who work and do business in Ontario – fast, accessible service and fair benefits at a fair price. Our health-care spending is focused on providing the best care possible to help people recover and return to work. People with allowed claims are automatically enrolled in the WSIB Drug Benefit program under specified categories of drugs – called formularies – related to their injury or illness, helping them to get quick access to the medications they require. Generic medication products and product extensions are automatically added to our formularies as they become available.

We spent $524.5M on health care for people with workplace injuries and illnesses in 2017; of this, $54.8M was spent on prescribed drugs.

This chapter gives an overview of the WSIB’s Drug Benefit program, including related initiatives and updates.

 

General overview

Our Drug Benefit program is supported by a number of resources, including:

  • The Drug Advisory Committee (DAC), established in 2007 to provide the WSIB with independent evidence-based expert advice on issues related to formulary management. It includes highly qualified independent experts from a variety of relevant clinical practice backgrounds in medicine and pharmacy and includes a member of the public. The committee reviews and recommends drugs based on the latest usage, benefits, value and safety evidence. These evidence-based recommendations help the WSIB decide on what drugs are included in the WSIB Drug Benefit program.
  • External independent drug reviews on the efficacy, safety, and cost-effectiveness of drugs.
  • An evidence-based approach to opioid and narcotics management.

In 2017, we published all of our drug formularies on our website. This regularly updated and complete listing of medications provides clinicians, pharmacists and others with a tool to help identify which drugs may be covered by the WSIB. We are the first workers compensation organization in North America to publically publish our drug formularies in full compliance with the American College of Occupational and Environmental Medicine’s position statement on Drug Formularies in Workers’ Compensation Systems.

 

Drug expenditures

Over the past five years, the volume of prescription drug claims has decreased steadily. There has been a 26 per cent decrease in the number of prescription drug claims between and including 2013 and 2017.

Prescription drug expenditures as a percentage of overall health care costs have declined by 23 per cent over the last five years.

 

These decreases are due in part to the WSIB’s narcotics strategy, patents expiring on  brand name drugs (generic equivalents are considerably cheaper) and work that’s been done to better support people with complex claims. Program and process improvements to our return-to-work program have also likely contributed to the decrease because access to specialized care and rehabilitation services is improving.



 

 

Generic substitution

A single-source drug is a brand-name drug that is still under patent with the manufacturer. Once the patent expires, the drug becomes “generic” and can be produced by other pharmaceutical companies, resulting in a significant drop in the price of the drug. Many highly used drugs now have lower-cost generic alternatives available.

The WSIB, in line with the Ontario government, supports the use of generic drugs – allowing the same access to drugs, but at significantly less cost.

In 2017, single-source medications comprised approximately 19 per cent of prescriptions. However, these drugs are significantly more costly because there are no generic competitors. As a result, single-source drugs represent 49 per cent of the WSIB’s total drug expenditures.

2017 prescription drugs breakdown for generic/brand/single source

The following chart illustrates the impact of generic utilization on drug expenditures. This commonly prescribed anti-inflammatory medication used for pain shows a significant drop in expenditures once it became generic.

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Commonly prescribed medications

The table below highlights the most commonly prescribed medications at the WSIB:

Acetaminophen/codeine/caffeine and oxycodone/acetaminophen represent opioid medications like Tylenol #1, #2, #3 and Percocet which are commonly used for short-term treatment of pain post-injury. 

Recent opioid guidelines in North America emphasize minimizing opioids and maximizing the use of non-opioids, particularly for long-term pain management. As a result, medications like acetaminophen (regular Tylenol) and naproxen/celecoxib (anti-inflammatories) are being used. Gabapentin, amitriptyline and pregabalin for the treatment of long-term neuropathic pain are also being prescribed more compared to ten years ago when opioids were more frequently used.

The list demonstrates how new evidence and practice guidelines have influenced prescribing and usage of medications in the WSIB’s Drug Benefit program.   

 

Opioid (narcotic) management

In 2010, the Narcotics Safety and Awareness Act was enacted and the WSIB followed with its own opioid initiative to encourage safe and proper use of prescription narcotics for non-cancer pain, using published pain treatment guidelines. The number of WSIB drug claims for opioid medications declined by 47 per cent since 2010 in part because of the WSIB’s approach to opioid management, which is helping to address the opioid crisis in Ontario. Today, fewer people with workplace injuries and illnesses are using or being prescribed opioids. The overall daily dosages of narcotics have decreased and the number of individuals on high-dose opioids (morphine equivalent dose, MED) has also decreased year over year.

Following best practice guidelines, the WSIB has helped facilitate the shift to more appropriate prescribing by sharing these practices with primary health-care professionals and ensuring access to specialists.

 

Injured wokers on high opiod doses are those with an “Average Daily Morphine Equivalent Dosage (MED) greater than 200mg”.

 

The WSIB approach to opioid management is helping to address the opioid crisis in Ontario. We have fewer workers using opioids, fewer opioids being prescribed, daily dosages of narcotics have decreased and the number on high dose opioids have decreased.

Following best practice guidelines, WSIB has helped facilitate the shift to more appropriate prescribing by engaging prescribers, sharing best practices and ensuring access to specialist support.