March 17, 2023

California Reports on Low-Volume High-Cost Drug Trends

The California Workers’ Compensation Institute (CWCI) published a new report on low-volume high-cost drugs seen in workers’ comp. This is the first of three reports, with this report focused on anti-inflammatory and anticonvulsant medications.

According to the report, ibuprofen and naproxen represented two-thirds of anti-inflammatory drugs dispensed in 2021, with average payments between $12-$49.

However, high-cost anti-inflammatories drove up total costs. Fenoprofen calcium made up 1.4% of anti-inflammatory prescriptions, but they made up 33.2% of those payments, averaging $1,479 per payment. Ketoprofen only made up 0.6% of anti-inflammatory prescriptions, but made up 9.8% of payments, averaging $1,073 per payment.

Additionally, the biologic etanercept (Enbrel), only available as a brand drug, made up less than 0.1% of anti-inflammatory prescriptions, but made up 4.3% of those payments, averaging $7,716.

In regard to anticonvulsants, gabapentin constituted 70% of anticonvulsants dispensed, and 21.5% of anticonvulsant spend. Four other anticonvulsants – pregabalin, lacosamide, levetiracetam, and lamotrigine – accounted for 24.2% of anticonvulsant prescriptions, but 72.2% of anticonvulsant spend.

Pregabalin, which is subject to prospective utilization review (UR) under the California Workers’ Compensation Formulary, was the second most common anticonvulsant prescribed in 2021, but its 20.7% share of the anticonvulsant prescriptions was far below its 55.5% share of the payments.

Across anticonvulsants:

  • Lacosamide accounted for 0.7% of prescriptions and 8.3% of payments
  • Levetiracetam accounted for 1.7% of prescriptions and 6.3% of payments
  • Lamotrigine accounted for 1.1% of prescriptions and 2.4% of payments

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