The California Workers’ Compensation Institute (CWCI) reported that the NSAID meloxicam has emerged as the largest source of anti-inflammatory drug spending in California workers’ comp, with its share of spending among NSAIDs rising from 1.7% in 2020 to 30.8% in 2025.

Meloxicam’s share of NSAID spend grew from 10.3% in 2020 to 14.7% by 2025, driven largely by a small number of high-cost meloxicam capsule prescriptions that sharply increase the drug’s average payment.

The average payment for a meloxicam prescription rose from $9 in 2020 to $92 in 2025. The median payment in 2025, however, was still less than $14, indicating that most prescriptions remained inexpensive. The payment distribution for meloxicam prescriptions highlights the disparity, as 56% of the 2025 prescriptions had payments of less than $15 while 4.7% of meloxicam payments ranged from $500 to $2,287.

A review of NDC codes, dosages, and formulations associated with 2025 prescriptions found that four high-cost, generic 5 mg and 10 mg meloxicam capsule formulations accounted for 12.6% of the workers’ compensation meloxicam prescriptions but 75.7% of the total payments for the drug.

The CWCI claims that these cost findings highlight an unresolved issue with California’s MTUS Drug Formulary. While the data do not establish the clinical rationale for individual prescriptions, they identify the capsule formulations as an area warranting close attention. More complete drug identification in the MTUS Formulary would also help claims administrators, utilization review organizations, physicians and other stakeholders distinguish between formulations and apply the formulary’s intended treatment and review requirements.