June 4, 2021

Interstate Variation and Trends in Workers’ Comp Drug Payments

The Workers’ Compensation Research Institute (WCRI) published a new flash report on Interstate Variation and Trends in Workers’ Compensation Drug Payments from Q1 of 2017 to Q1 of 2020.

This report presents data on prescriptions paid in workers’ comp for key therapeutic groups by quarter and across 28 states. These groups represent the large majority of all prescription payments in workers’ comp, including:

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

This study provides a high-level view of changing costs of prescription drugs in workers’ compensation across 28 states, demonstrating where workers’ comp prescribing dollars are being spent and whether spending for those groups of drugs is going up or down.

Overall, quarterly prescription payments per claim decreased 15% or more in 20 states from 2017-2020. However, quarterly prescription payments varied widely in Q1 of 2020, ranging from an average low of $24-$25 in states like California, Minnesota, and Wisconsin, to as high as $206 in Louisiana. Interestingly, Connecticut saw a 30% increase in quarterly prescription payments during the study period

WCRI found that in most states, dermatological agents and NSAIDs are more important than other drug groups as a share of total prescription payments. In a median of the 28 study states, these drugs accounted for 20% of total prescription payments in Q1 of 2020. Payments for these drugs rose, while payments for opioids, compounds, and anticonvulsants decreased overall.

Per-claim payments for dermatological agents varied from $7 per claim in Iowa to $190 in Louisiana, while per-claim payments for NSAIDs varied from $21-22 in Delaware and Massachusetts to $126 in Louisiana.

Anticonvulsants made up the third highest share of total prescription payments, though anticonvulsants experienced a decrease in payments between Q2-Q3 of 2019, due to the availability of new generic formulations of Lyrica.

Musculoskeletal therapy agents made up the fourth largest share of prescription payments. Musculoskeletal therapy agents saw very little changes across the nation, other than 30-65% decreases in utilization in five states.

Opioids made up the fifth largest share of prescription payments, with prescribing continuing to decline across the nation at an average of 56%. Trends varied across states; in Louisiana, opioid prescribing dropped 40%, and in California it decreased 81%.

Additional key highlights from the study include:

  • In Q1 of 2020, 50% or more of prescription payments in Florida, Georgia, Illinois, and Maryland were for physician-dispensed drugs
  • Antidepressant payment shares were stable in most states, though increases ranging from 8-10% were seen in Iowa and Minnesota
  • Compounds now make up a small percent of payments in all 28 states
  • Other drug groups – including anticoagulants, antiemetics, antiretrovirals, antibiotics, and ulcer drugs – account for 26% of prescription payments as of Q1 of 2020, an increase of 7% since Q1 of 2017
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