Ontario’s Workplace Safety and Insurance Board spent 33 per cent less on prescription drugs in 2015 than it did in 2010. The board has claimed the $34-million difference was due to lower drug prices and fewer claims entering the system. But a Toronto legal clinic is arguing the cost savings actually stem from reduced services to injured workers.

If cheaper drugs had led to lower spending, the average cost per claim should have dropped as well, the Industrial Accident Victims Group of Ontario argues in a new report. But in 2010, the average claim was $1,382; five years later, it was $1,319.

“By 2015, the cost per claim was 95 per cent of its 2010 level, whereas overall drug spending had decreased dramatically, to 65 per cent of the 2010 amount,” the report notes.

Read: Sounding Board: Employers fear WSIB mental-health claims will put them out of business

The legal clinic also points out that a decline in the number of drug claims doesn’t mean fewer injured workers need the benefits. Instead, it argues the WSIB is both accepting fewer claims and making the claims process so onerous that workers choose to submit their benefits elsewhere.

The report notes that in the past seven years, the WSIB removed a significant number of drugs from its formularies, including some that are commonly prescribed to treat pain and psychological conditions (the WSIB has since restored some of them). According to the report, if an injured worker submitted a new claim for one of the medications, it was automatically denied. If a worker had been claiming a drug before its removal from the formulary, those benefits were then rescinded. If the drug was restored to the formulary, the WSIB didn’t attempt to tell the affected workers they might get the benefit back, the report suggests.

Read: The debate over drug formularies

Since patients on stable, long-term drug therapy regimes aren’t keen to change their medications simply because a formulary has changed, those who are able to access other insurance plans are likely to submit their claims to them. “This removes those workers’ claims from the WSIB’s drug benefit program and shifts some of the cost of their workplace injury to private insurers or provincial social programs,” the report noted.

Read: WSIB makes formularies public and searchable

Another issue is the secrecy around which drugs the WSIB will cover. The WSIB publicized its formularies in January 2017, but before then, workers wouldn’t know whether it would cover their prescriptions until they arrived at the pharmacy. They would then have to make another appointment with their family doctor to try a different drug, return to the pharmacy and hope for a better outcome.

“Faced with this situation, some workers simply gave up on the WSIB,” the report noted. “They either found another way to pay for the medication originally prescribed to them (because they reasonably believed that, as it was prescribed for them by their treating physician, it was the appropriate treatment for their injury), or resorted to self-medication with alternatives such as over the counter medications, alcohol or drugs obtained on the street.”

The WSIB’s administrative requirements for physicians treating claimants are onerous, and the report points to some family doctors who refuse to take them on as patients. It notes some physicians will encourage injured workers to use insurance plans other than the WSIB, if they have coverage.

Read: What’s the role of doctors in boosting drug plan sustainability?

“When people come to us, it is because their lives have changed, sometimes forever,” Christine Arnott, a spokesperson for the WSIB, said in an email to Benefits Canada. “It’s often a very difficult time for them and we are here to help. We focus our health care spending where it belongs — on providing the best care possible for people who have been injured to help them recover and return to work. We are proud that we have been able to invest more in health care per claim while reducing drug costs, removing large profits for big pharmaceutical companies. Decisions regarding an injured worker’s care are made on a case by case basis based on medical evidence and expertise.”

Note: This story was updated at 12:15 p.m. on May 25 to include Arnott’s comments.

Copyright © 2017 Transcontinental Media G.P. Originally published on benefitscanada.com
See all comments Recent Comments

anita:

WSIB needs to stop enforcing people with workplace injuries to take lower cost drugs that don’t work as well as drugs that their doctors prescribe. Asking someone that is off work to pay or copay for something that WSIB is responsible for is wrong. WSIB clients that use their website to access their information regarding their claims and payments to them should not be denied the access to their accounts – what kindof impression are they giving. telling their clients that they no longer will give them info by mail then telling them to use an access code/password on their website then saying that password is not valid – and not helping by phone when they call them. is wrong. WSIB needs to get it right with their clients or be held accountable.

Sunday, May 28 at 4:34 pm | Reply

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