The 5%: On more medications (Especially pain medications)


The 5%

As we have shown in earlier blogs, “the 5%” is comprised of workers who are spending the most in total integrated benefits costs and are accounting for about 50% of all costs. On average, the 5% receive more than ten medications and see ten providers annually.

Because total benefit costs for the 5% are 20 to 30 times higher than the 95%, one can expect a higher rate of utilization in every area.

Pain medications are the most frequently prescribed class of medication.  Pain is not usually a unique condition, but instead a symptom of another condition or a result of a procedure.

The Research

In this investigation, we examined and compared the top 5% to the other 95% of a population of over 265,000 employees in HCMS Group’s Research Reference Database (RRDb) during 2011. The analysis of medication use focused on those who had at least one prescription medication during the year.

Medication Finding

As seen in the chart below, the most common type of medication in both the 5% and the 95% groups was in the Central Nervous System (CNS) class.  However, the rate of use of CNS medications doubled in the 5% group.

(click to enlarge)

Trends of those taking Central Nervous System (CNS) Medication

Within the CNS category, the most common type of prescription was a narcotic agent combined with a non-narcotic analgesic, followed by non-steroidal anti-inflammatory medications (such as ibuprofen, also known as NSAIDS).

Among the 5%, two-thirds had a narcotic combination and another 13% had a prescription for narcotics (not in combination). Less than one quarter of those in the 95% had a prescription for either of these medications in 2011.

(click to enlarge)

Key Findings:

  • Pain appears to be a significant element of the illness experience of the 5% and it is most often treated using narcotic agents
  • Those in the 5% had a 2:1 ratio of narcotics to NSAIDs, while those in the 95% had a ratio of 1.24:1
  • Among the 5%, over two-thirds had at least one narcotic prescription

These findings have significant implications for supporting people in the 5% and encouraging coordination of care among the many providers the 5% sees and the many treatments they face.



Leave a reply