The Workers Compensation Research Institute (WCRI) published the sixth edition of their report on Interstate Variation and Trends in Workers’ Compensation Drug Payments, which provides a high-level view of changing prescription drug costs across 31 states.

The analysis is based on prescriptions dispensed for non‑COVID-19 claims, with injuries occurring within three years of the prescription fill date (Q1 of 2022 to Q1 of 2025) and paid under workers’ comp each quarter.

According to the WCRI, the long-term decline in prescription payments since 2015 has reversed, with prescription payments per medical claim increasing in a majority of the 31 study states. This increase in prescription payments is driven by higher cost per prescription and not an increase in prescribing.

Dermatological agents remained a significant cost driver, accounting for 23% of prescription payments in the median study state, exceeding 30% in 12 states in Q1 of 2025. Physician dispensing and delivery pharmacies accounted for more than 70% of prescription payments for dermatological agents in 20 out of the 31 study states. In states with the highest dermatological payment shares, these channels accounted for 80-95% of dermatological payments.

It is worth noting that reimbursement limits on topical medications significantly reduced dermatological payments in Georgia and South Carolina. Georgia saw payment shares drop from 55% to 17% from 2024-2025 due to these changes, which took effect April 2024.

NSAIDs made up 15% of prescription payments in the median study state, ranging from 7-32% of prescription payments across states. Across multiple drug categories, a limited set of high-priced products accounted for a notable share of prescription payments. A few NSAID examples of this were diclofenac sodium 2 percent solution, diclofenac potassium 25 mg tablets, methyl salicylate 25 percent cream, methyl salicylate 10 percent patch, and delayed-release naproxen-esomeprazole magnesium 500-20 mg tablets.

Migraine drugs emerged as a growing cost component, rapidly following the introduction of new calcitonin gene-related peptide therapies. Migraine drugs accounted for 10-26% of prescription payments in states with the highest drug payment shares, compared to 1-3% in the 11 states with the lowest share.

Overall, payment shares for other key drug groups remained generally stable across the study period.