The California Workers’ Compensation Institute (CWCI) published a new report on Psychotherapeutic & Neurological Drugs, providing insights on a new emerging drug trend.
Based on data from CWCI’s Prescription Drug Interactive Application and Industry Research Information System database collected from 2015-2024, the report found that while psychotherapeutic and neurological drugs represented only 0.2% to 0.3% of all California workers’ compensation prescriptions throughout the 10-year study period, their share of total pharmacy payments in the system increased nearly fivefold, climbing from 0.7% in 2015 to 3.4% in 2024.
This has placed this drug category among the 10 most costly drug groups in California’s workers’ comp system. The study attributes much of that surge to the use of certain high-priced brand medications within the drug group.
The study identified five drugs that accounted for 92.9% of psychotherapeutic and neurological prescriptions and approximately 60% of total payments in this category in 2024:
- Memantine HCl (Namenda)
- Donepezil HCl
- Gabapentin enacarbil ER (Horizant)
- Once-daily gabapentin (Gralise)
- Dextromethorphan HBr/quinidine sulfate (Nuedexta)
Among these, Nuedexta emerged as the primary cost driver within this group, with its share of prescriptions quadrupling from 8.6% in 2015 to 35.9% in 2024, while the average payment doubled from $659 to $1,317. This has driven its share of drug spend in this group from 13.9% to 41.2%.
A review of diagnosis and body part codes on claims in which Nuedexta and other psychotherapeutic and neurological medications were prescribed suggests some off-label use of these drugs for conditions unrelated to FDA-approved indications or the Medical Treatment Utilization Schedule (MTUS)/ACOEM Guidelines.
CWCI also points to broader factors influencing prescribing trends, including reduced opioid use, increased reliance on alternative pain therapies, and specialty drug pricing.
