July 17, 2022

Interstate Variation and Trends in Workers’ Comp Drug Payments

The Workers’ Compensation Research Institute (WCRI) published Interstate Variation and Trends in Workers’ Compensation Drug Payments: 2018Q1 to 2021Q1 —A WCRI FlashReport, which provides a high-level view of changing costs of prescription drugs in workers’ compensation across 28 states.

This report examines trends in drug payments for non-COVID-19 claims from Q1 of 2018 through Q1 of 2021, utilizing data from payers across the 28 study states, which represented 35-67% of all medical claims in workers’ comp across those states.

The report focuses on quarterly payment shares and payments per claim for seven key drug therapy groups:

  • Dermatological agents
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Anticonvulsants
  • Musculoskeletal therapy agents
  • Opioids
  • Antidepressants
  • Compound drugs

Overall, quarterly prescription payments per medical claim decreased by 15% or more in 18 of the 28 study states, with significant increases in Connecticut (22%), Florida (17%), and Pennsylvania (14%).

In Q1 of 2021, quarterly prescription payments per medical claim varied greatly across states, as low as $22 per claim in states such as Massachusetts, Minnesota, and Wisconsin, to as high as $200 per claim in Florida and Louisiana.

Dermatological agents accounted for 20% of prescription drug payments in most states, with increased spending driven by greater dispensing of high-priced drug products at physicians’ offices or mail-order pharmacies. Physician dispensing accounted for the majority of payments for dermatological agents in 13 of the 28 study states in Q1 of 2021.

Meanwhile NSAIDs accounted for 18% of prescription drug payments in most states, remaining stable over the years. One exception was in California, where quarterly payment share and per-claim payments for NSAIDs increased substantially, driven by higher-priced drug products such as fenoprofen and ketoprofen.

Both anticonvulsants and musculoskeletal agents accounted for 10% of prescription payments each. Payment share and per-claim payments for anticonvulsants decreased in many states for anticonvulsants, with quarterly payments per claim varying from $5 in California to $55 in Louisiana. Musculoskeletal agents saw only minor changes in payment share and per-claim payments, though formularies in New York and California did drive down payments by 44-50%.

Opioid prescribing continued to decline in all 28 study states, with per-claim payments for opioids decreasing an average of 56%. However, there was still a large variation in payments per claim for opioids across states, as high as $54 in Louisiana and as low as $3 in California.

Antidepressants payment shares went up or down by 3% or less in all states except Tennessee. Tennessee and Minnesota saw payment shares for antidepressants reach a high of 9%. Payment shares for antidepressants were under 5% in 18 of the 28 states.

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