Making Sense of Workers’ Comp Pharmaceuticals During COVID-19


When the COVID-19 pandemic became a serious concern all the way back in March, businesses had to find a way to adapt. Since it is abundantly clear that this is in no way a short-term problem, it is all the more critical to start to look back and analyze some of the data from the earlier months. 

The future is never easy to predict, and major events such as COVID-19 create even more uncertainty by disrupting the data that projections are typically based on. In the case of workers’ compensation, where workplace injury rates are correlated with employment, the effect on both new workers’ compensation claims and existing cases has been difficult to fully comprehend. 

Recently, we sat down with two of our leaders who have been particularly devoted to understanding and answering these questions. Elijah Marentette, Senior Vice President of Account Management and Cliff Belliveau, Vice President of Business Intelligence (BI), have both deeply involved themselves in collecting, organizing and analyzing the data that has become available since the initial outbreak. As they use the information they’ve uncovered to help guide myMatrixx and our partners and clients through this complex situation, the two have found that some of the data lines up with logical predictions, but there have also been surprises. 

Understanding the initial response to the pandemic

Although the virus was making headlines throughout early 2020, it’s safe to say that few were prepared for the swiftness that the COVID-19 pandemic upended everyday life in mid-March. Businesses around the world had to quickly find a way to work from home. Those that couldn’t had to find a way to operate safely or close down. As a workers’ compensation PBM, myMatrixx had to not only shift operations from normal worksites without missing a beat, but also start to immediately make sense of the effect this growing pandemic would have on both new and existing claims. 

Since the vast majority of the workload for workers’ comp claims professionals is on existing cases, initially there wasn’t much of a change in the workload. This is why the myMatrixx team understood the importance of a rapid shift to remote work. In fact, according to Elijah, many of these claims had new challenges to deal with that could increase the time and attention required to maintain them. “Injured workers may not have been able to go to their doctor, physical therapist or chiropractor to get the therapy that they need to feel better. Workers’ comp claims were not getting priority in hospitals, so necessary surgeries and other treatments, those were not happening.” 

What clearly declined in the ensuing months was new claims, and by extension, new prescriptions. According to Elijah, “In early 2020, we were holding steady with our prescription numbers from the previous year, and all the sudden we all went home in the middle of March, and the number of prescriptions being filled saw a steep decline.” 

However, the data is pointing to some signs that there is starting to be a rebound. As Cliff puts it, “Looking at January through June of 2020, we do see an appreciable difference year-over-year for the same time range in 2019. However, there are indicators that the gap is starting to close.” He stresses that this should be taken with appropriate caution. “We don’t want to feel too good that we’re closing the gap in the period we’ve studied, because with the recent resurgence, we’re right back in it again.The levels are returning to their normal state very slowly. They fell off much more quickly than they are recovering.” 

Higher unemployment means less claims — but that isn’t the whole picture

Nobody in the industry was surprised that the massive unemployment that came in the wake of the pandemic would also lead to a reduction in workplace injuries. Says Cliff, “Typically, the unemployment rate is a leading indicator of workers’ comp claims. In general, if you’re not at work, then you are not likely to become an injured worker.” But how this fact relates to other emerging statistics, including changes in prescription utilization, is a little more difficult to answer. 

“The question that we may want to try to answer is do they track in any particular pattern or is it kind of this linear correlation that’s just like people start getting back to worksites, they get hurt, they fill prescriptions. The question that clients are posing is, what is happening in workers’ comp as unemployment takes its toll during the pandemic.” Says Elijah. 

According to Cliff however, the source of a particularly appreciable drop-off in prescriptions for April may be about more than simply less workplace injuries. “We can be fairly confident that much of the April drop-off was due to injured workers who were not visiting retail pharmacies for refills. In late May, we began to open and injured workers resumed visits to pharmacies. Those visits drove the slight rebound in filled prescriptions.” How this will continue to affect prescription fill rates for injured workers throughout a persistent outbreak of the virus will remain to be seen.

The new normal — working through uncertainty

In recent months, it’s become all too clear that COVID-19 will be an ongoing concern in this country. A resurgence in cases in July has also made it more difficult to gain an understanding of how workers’ compensation cases will be affected. Even when analysts might have been just starting to feel like they were grasping the situation. 

“We were in a mode of uncertainty in March, but with the recent spikes that uncertainty has been amplified,” says Cliff. “There are two influencing dynamics at play here, one is empirical and the other is not. The first dynamic is the set of the variables that we can measure, such as unemployment, COVID cases, positivity ratios, hospitalizations, etc. The second dynamic is what we can’t measure with a high degree of certainty: how leadership and businesses are going to respond.”

Despite this fog of uncertainty, the entire myMatrixx team is committed to using the information and resources available to help partners and clients in whatever way possible. Says Elijah, “We’re giving advice to customers on how they should keep their workforce safe and healthy for the long haul. Being a part of the larger Cigna-Express Scripts organization gives us access to great resources and advice. No matter what, setting good policy is going to be absolutely essential as businesses get back to whatever their new normal turns out to be.”