With opioid utilization down, there is no longer a consolidated driver of pharmacy costs in workers’ comp. Instead, the industry faces a growing diversity of smaller, niche trends that require more strategic formulary and clinical management across different populations and geographies.
Right now, 4 drug classes driving pharmacy costs include:
#1. High-Cost Oral NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) have long been recommended as a safe and appropriate therapy for pain management associated with workplace injury. Indeed, the use of NSAIDs has grown rather steadily as opioid utilization has decreased, which is not unexpected.
While NSAIDs are relatively safe medications, within such a large class of drugs there can be outlying trends of concern. For instance, per-claim payments for NSAIDs in workers’ comp were as low as $21 in Massachusetts and Minnesota and as high as $129 in Florida. While such differences in spending could be tied to fee schedules, different worker populations by state, or any number of reasons, such a range in spend indicates there are opportunities to lower costs.
#2. Dermatological Agents/Topical Analgesics
While these terms are not completely interchangeable, both dermatological agents and topical agents can be described as pain medications applied directly on the skin at the area to be treated. Such products can include creams, gels, ointments, and more.
Dermatological agents account for 20% of prescription drug payments in workers’ comp. Initially making up a smaller portion of drug spend, drug spend on dermatological agents has risen steadily over the last few years due to greater dispensing of high-priced drug products, often at physicians’ offices or via mail-order pharmacies – another illustration of an inconsequential trend with significant overall impact.
Anticonvulsants are medications used for the treatment of seizures. However, these medications are being used more and more to treat neuropathic pain, often-times off-label.
Overall, payment shares and per-claim payments for anticonvulsants have decreased, particularly due to the introduction of generic formulations of Lyrica. While this bodes well, anticonvulsants are still among the top drugs by payment share in most states. One thing that makes cost analysis concerning is that a majority of prescriptions for anticonvulsants are attributed to off-label prescribing. While off-label prescribing can be medically warranted and beneficial for patients, at times it can be clinically inappropriate and cost-ineffective.
#4. Specialty and Other Drug Classes of Note
Across different drug classes there have been minor increases in spending, and while individually they are all relatively small increases, there are two things to consider. First, their collective total increase in spending does accumulate. Second, depending on the specific worker populations a workers’ comp program may cover, these drug trends may be more relevant and impactful for certain payers.
Drug classes with minor increases in spending include migraine drugs, anticoagulants, and antiretrovirals. In particular, the migraine drug market continues to experience rapid growth, with global sales of $10.86 billion projected by 2030, and these products are becoming more utilized in workers’ comp.
For a more in-depth look at pharmacy cost drivers, read the winter RXInformer article, Things Change: The Growing Diversity of Pharmacy Cost Drivers.