An inexpensive, once-a-day arthritis pill has quietly become the biggest anti-inflammatory drug expense in California workers’ compensation, and nearly all of the increase traces to a handful of specialty capsules. In a November 3, 2026 release, the California Workers’ Compensation Institute (CWCI) reported that meloxicam’s share of anti-inflammatory drug spending in the state’s comp system rose from 1.7 percent in 2020 to 30.8 percent in 2025. Over the same period, its share of anti-inflammatory prescriptions grew much more slowly, from 10.3 percent to 14.7 percent.
The gap shows up most clearly in the average payment per prescription. According to CWCI, it climbed every year, from $9 in 2020 to $13 in 2021, $30 in 2022, $41 in 2023, $63 in 2024 and $92 in 2025. Yet most meloxicam prescriptions remain cheap: in 2025 the median payment was still under $14, and 56 percent of prescriptions were paid at less than $15. At the other end, 4.7 percent of prescriptions were paid between $500 and $2,287.
CWCI traced that spread to dosage form. When it reviewed the National Drug Codes on 2025 meloxicam prescriptions, it found four high-cost generic 5-mg and 10-mg capsule products, from Lupin Pharmaceuticals or Novitium Pharma and dispensed in quantities of 30 or 60. Those capsules made up 12.6 percent of meloxicam prescriptions but 75.7 percent of meloxicam payments. Conventional 7.5-mg and 15-mg tablets accounted for about 87 percent of prescriptions at about $23 each, but only about 22 percent of spending.
According to CWCI, the capsules use a fine-particle formulation first developed for the brand-name product Vivlodex, which has since been discontinued. The institute points to the FDA-approved labeling, which says the capsules have not shown systemic exposure equivalent to other oral meloxicam and are not interchangeable with them, even at the same milligram strength (see the Vivlodex label on DailyMed). The labeling does not establish any reduction in cardiovascular risk, and the capsules carry the same NSAID warnings as other forms.
The release also flags a regulatory gap. CWCI says the Division of Workers’ Compensation’s Pharmacy and Therapeutics Committee discussed treating the capsules separately from conventional tablets on the MTUS Drug Formulary, and the distinction appeared in 2020 and 2021 draft drug lists. It was not carried into the final published lists. CWCI says the current lists can’t tell the products apart because the RxNorm identifier fields needed to do so are incomplete. Committee members have repeatedly urged DWC to complete those fields, and CWCI expects the issue to come up again at the committee’s January meeting. The release was corrected after publication: an earlier version had said the capsules were already classified as non-exempt. CWCI also cautions that its data cannot establish the clinical rationale for any individual prescription.
How meloxicam became a top seller. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) developed by Boehringer Ingelheim. The FDA approved it in 2000 under the brand name Mobic. Its rise came largely from the downfall of a competitor. After Merck withdrew the COX-2 inhibitor Vioxx in September 2004, a Consumer Reports Best Buy Drugs analysis found that Mobic prescriptions jumped 136 percent in six months, the biggest gain among Vioxx alternatives. Mobic had been heavily advertised as a substitute (The Pharma Letter). Generics then made it cheap: in July 2006 the FDA approved the first generic versions, clearing 13 applications at once under a new “cluster” review process (UPI).
Meloxicam’s pharmacology helps explain why prescribers stayed with it. Its elimination half-life of 15 to 20 hours allows once-daily dosing, according to the FDA-approved tablet label. Pharmacology references also describe it as COX-2 preferential, meaning that at usual doses it leans toward the enzyme behind inflammation. That property has been linked to somewhat less stomach irritation, though it does not remove the drug’s gastrointestinal or cardiovascular risks. Today it is the most-prescribed NSAID in the country. The ClinCalc DrugStats database, which draws on federal survey data, estimates about 20.7 million U.S. prescriptions in 2023, ranking it 27th among all drugs. The low-dose capsule came later. Iroko Pharmaceuticals won FDA approval for Vivlodex in October 2015 and promoted its submicron-particle technology as a way to follow FDA advice to use the lowest effective NSAID dose (Drugs.com).
Meloxicam tablets are approved for the signs and symptoms of osteoarthritis and rheumatoid arthritis, and for juvenile rheumatoid arthritis in patients weighing at least 60 kg. The 5-mg and 10-mg capsules are approved only for osteoarthritis pain. For payers and prescribers, the drug’s appeal is a non-opioid, once-daily anti-inflammatory that costs pennies in generic tablet form.
Like all prescription NSAIDs, meloxicam carries a boxed warning. It raises the risk of serious cardiovascular events, including heart attack and stroke, which can be fatal and can occur early in treatment. It can also cause serious gastrointestinal bleeding, ulcers and perforation, sometimes without warning. The FDA strengthened the cardiovascular warning in 2015, noting that the risk was seen most consistently at higher doses. The tablet label lists diarrhea, upper respiratory infections, indigestion and flu-like symptoms as the most common side effects in trials. It also warns of high blood pressure, heart failure and fluid retention, liver injury, serious skin reactions and anemia.
Kidney risks are the most relevant for long-term users. The tablet label warns that long-term NSAID use can cause kidney tissue damage (renal papillary necrosis), kidney insufficiency and acute kidney failure, and can raise blood potassium. Risk is highest in older patients and in those who already have reduced kidney function, are dehydrated, or have heart failure or liver problems. Patients taking diuretics, ACE inhibitors or angiotensin receptor blockers are also at higher risk. The label advises against using meloxicam in advanced kidney disease unless the benefits clearly outweigh the risk. It caps the dose at 7.5 mg a day for hemodialysis patients and calls for monitoring kidney function in at-risk patients. For the capsules, the Vivlodex label sets a 5-mg maximum for dialysis patients. The research generally supports these cautions. A 2017 systematic review in BMC Nephrology estimated that current NSAID use raised the odds of acute kidney injury by about 73 percent in the general population, with higher risk in older people. A 2019 JAMA Network Open study of more than 760,000 active-duty Army soldiers found that the highest prescribed NSAID doses carried modestly higher risks of acute and chronic kidney disease, even in young and middle-aged adults, although absolute rates were low. In 2020, the FDA also warned against NSAID use at about 20 weeks of pregnancy or later because of rare but serious kidney problems in the unborn baby.
For employers and claims administrators, the CWCI findings point in two directions. On cost, nearly all of the growth in meloxicam spending comes from capsules that the labeling says are not interchangeable with cheap tablets, and the formulary does not yet treat them differently. On safety, long courses of meloxicam in injured workers, particularly older workers and those taking blood pressure medications, call for the kind of kidney monitoring the label already recommends.