If you ascribe to the generally accepted principles that most employees don't wish to become sick or injured and miss work, and most employers don't wish to use valuable resources providing workers compensate packages, it's hard to imagine why workers' compensation would be seen as anything other than a necessary workplace safeguard.

But talk about workers' compensation with pharmacy benefit managers (PBMs), the third party administrators of prescription drug programs, and their eyes instantly light up. That's because for PBMs, workers' compensation provides a great opportunity for increased profits without increased work.

In the shadowy world of pharmacy benefits management, exploiting workers' compensation reimbursement rates is one of the many ways PBMs ensure their own massive profits while ultimately driving up drug costs for employers and consumers. Workers' compensation reimbursement fees for prescription drugs are often set by state statute at rates between 10 and 40 percent more than a drug's average wholesale price. So when employers pay the PBM based on the reimbursement benchmark set by the state, the difference between what the drug costs and what the employer pays, often called "the spread," goes straight to the PBMs' bottom line.