New data from the California Workers’ Compensation Institute (CWCI) shows recent shifts in the types of drugs prescribed to injured workers in California, and in the distribution of payments for those medications, with anti-inflammatory drugs ranking first in terms of the number of prescriptions, but dermatologicals, which include a number of high-priced, private label drugs, accounting for the biggest share of the total drug spend.
A review of total payments by drug ingredient shows that from January through June of last year, the dermatological lidocaine (average payment $159: $216 brand, $151 generic) ranked first among all drugs in terms of the California workers’ compensation total drug spend, accounting for 8.5% of all payments. That was more than twice the percentage noted for the anti-inflammatory naproxen, which ranked second with 4.2% of the prescription dollars, just ahead of the anticonvulsant pregabalin, which ranked third with 4.1%. The dermatological diclofenac sodium (topical) ranked fourth, consuming 3.1% of the pharmaceutical payments, while the anti-inflammatory meloxicam and the migraine drug rimegepant sulfate rounded out the top 6 drugs, each consuming 2.8% of the total drug spend in the first half of 2024.
CWCI analysts noted the shifts in prescription drug utilization and reimbursement among the drug groups suggested an association between the ongoing decline in opioid use with the state’s adoption of the Opioid and Pain Management Guidelines into the Medical Treatment Utilization Schedule (MTUS) in late 2017, and the implementation of the MTUS Formulary in 2018.
The historical data show that anti-inflammatories such as ibuprofen and naproxen, often used as non-narcotic alternatives to treat pain, surpassed opioids to become the top drug group in 2016, and by 2021 they accounted for a record 35.3% of all prescriptions dispensed to California injured workers.
Dermatological drugs are often used to treat pain, and with opioid use declining their share of the workers’ comp prescriptions grew from 4.9% in 2016 to 12.6% in the first half of 2024. Though many different dermatologicals are used to treat injured workers, the breakdown by drug ingredients shows most of that growth was due to the increased use of prescriptions containing lidocaine and/or diclofenac sodium, which together increased from 46% of the dermatological prescriptions in 2016 to 81.6% in the first half of 2024.
In 2022, anticonvulsants, which are often used to treat neuropathic pain, surpassed opioids to become the third most prescribed workers’ comp drug group and since then they have maintained that ranking, while antidepressants surpassed opioids in 2023 (accounting for 8.0% of the prescriptions) and they remained the fourth most prescribed drug group in the first half of 2024 (8.1%).
Like opioids, musculoskeletal drugs have seen their share of the prescriptions drop sharply over the past 8-1/2 years, falling from 10.7% of the prescriptions in 2016 (third behind anti-inflammatories and opioids) to 5.8% in 2021 before they leveled off at just over 6% over the past 2-1/2 years (sixth among all drug groups). This decline coincided with the implementation of the Formulary in January 2018, as under the Formulary, musculoskeletal drugs are not exempt from utilization review except for limited special fill or perioperative use where only limited quantities can be dispensed.
CWCI has published additional details and complete lists of the top 10 California workers’ compensation therapeutic drug groups based on prescription volume and payments from 2016 through June of 2024 in Bulletin 2025-01.