A new FlashReport from the Workers Compensation Research Institute (WCRI) finds that in most states, dermatological agents and nonsteroidal anti-inflammatory drugs (NSAIDs) have become more important than other drug groups as a share of total prescription payments. The 28 states in the study include California.
“This study finds that prescription payments are decreasing in a majority of state workers’ compensation systems, but prescription payments continue to vary widely,” said John Ruser, president and CEO of WCRI. “This study breaks prescription drugs into groups (dermatological agents, NSAIDs, opioids, compounds, etc.) so you can see where workers’ compensation prescribing dollars are being spent and whether spending for those groups of drugs is going up or down.”
The following is an abbreviated list of the study’s other findings:
– – Dermatological agents: Per-claim payments varied widely, from $7 per claim in Iowa to $181 per claim in Illinois and $190 per claim in Louisiana in 2020Q1. Physician dispensing accounted for the majority of payments for the drug group in 12 of the 28 study states. Between 2017Q1 and 2020Q1, payment shares increased by more than 10 percentage points in 5 states (Connecticut, Kansas, Louisiana, South Carolina, and Virginia) and physician dispensing contributed to the rapid growth.
– – NSAIDS: Payment shares for this drug group changed little in many states, but per-claim payments varied widely in 2020Q1, from $21-$22 per claim in Delaware and Massachusetts to $126 per claim in Louisiana.
– – Anticonvulsants: Both payment share and per-claim payment for this group decreased in many states over the study period. The decrease happened mostly between 2019Q2 and 2019Q3, when generic formulations of Lyrica® became available.
– – Opioids: The substantial decline for opioids during the study period continues the declines seen in previous periods. The per-claim payments for opioids decreased by 56 percent in the typical state, and the rate of reduction ranged from 40 percent in Louisiana to 81 percent in California.
In the dermatological category, prescriptions for diclofenac sodium gel accounted for the majority of the prescriptions in the median state, Vennela Thumula, policy analyst for WCRI said, and lidocaine was also commonly prescribed.
While about 56% of the workers prescribed topical diclofenac had documented diagnoses of soft tissue injuries of joints – for which the drug is approved – about 40% of workers were using it for treatment not recommended, often for shoulder and back pain, she said.
Another cost driver in dermatologicals is private-label topicals, which are independently manufactured and not recommended by evidence-based guidelines and also have a much higher price tag compared to comparable products” approved by the Official Disability Guidelines Workers’ Compensation Drug Formulary, also known as ODG, Ms. Thumula said.
Among claims with topicals, private-label topicals are rarely dispensed in half of the study states, but at least a third of the claims have private-label topicals in Louisiana, New Mexico, Maryland, Illinois and South Carolina, and it’s even higher in Delaware,” she said.