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Overall drug cost and utilization were both down for workers’ comp payers in 2018. Combined with tighter regulatory control, this trend helped to reduce drug spend by nearly 4% over 2017.

That’s the key takeaway from myMatrixx’s 2018 Workers’ Compensation Drug Trend Report, which highlighted the industry’s progress toward decreasing reliance on opioids and better managing prescription authorization.

But though the overall outlook is positive for payers, some troubling trends are taking shape. Brand-name versions of the most common drugs prescribed to injured workers are 65% more expensive today than they were in 2014. Generics, on the other hand, have dropped 35% in price over the same time period. Across all myMatrixx payers, 86% of prescriptions filled were generic versions.

Together, lower prices and higher utilization of generics have driven an overall 0.9% reduction in unit costs.

Between 2019 and 2022, a number of brand name drugs will also lose patent protection, opening the door for manufacturers to bring more generic versions to market. Nine of these are indicted for pain and inflammation, and thus represent potential new alternatives to opioids as payers shift away from addictive painkillers.

Average opioid spending among myMatrixx payers has dropped by 15%, thanks to broad efforts at prescriber education and more aggressive prescription management. In 2017, 21% of injured workers used an opioid for at least 30 days. In 2018, that rate dropped to 17.6%.

Utilization among both NSAIDS and gabapentin – another non-opioid alternative – increased slightly, suggesting that prescribers are beginning to favor these non-addictive pain management drugs over opioids.

The use of compounds has been significantly curtailed to the point where they are nearly extinct in the world of workers’ comp. Utilization has decreased 24% since 2017, driving a 43% reduction in spending. In 2018, only 0.2% of medications were compound creams.

“We’ve pretty much eliminated compound creams from the picture,” said Rochelle Henderson, PhD & VP of Clinical Research at Express Scripts. “That being said, dermatologicals are growing as a category, and they will be an area to watch going forward.”