March 7, 2019

Tackling Topicals: Clinicians Takes Notice

The Annals of Internal Medicine recently published the results of a randomized controlled trial meant to determine the effectiveness of compounded topical pain creams. A total of 399 patients suffering from localized neuropathic pain (related to nerve damage) and/or localized nociceptive pain (caused by tissue injury) were given either one of two compounded pain creams or a placebo for the treatment of pain.

The study found no statistically significantly differences in pain reduction between patients using a compounded topical or a placebo, indicating that the topicals offered no clinical benefit, especially considering their high cost.

Topicals – in compounded forms and as private-labeled products – can inflate the cost of a claim while offering little-to-no clinical benefit for patients. However, as prescribing trends continue to shift, it appears topicals are seeing greater utilization.

Last month the California Workers Compensation Institute (CWCI) released a research update that looked at 5.75 million prescriptions dispensed in the California workers’ comp system from January 2009 to June 2018. Among many insights, the CWCI report found that prescription and private-labeled dermatological topicals saw a serious increase in spend. In 2009, these dermatological topicals made up 10.1% of drug spend, increasing to 17.6% in 2018, making it the drug class with the highest spend in 2018, surpassing opioids.

News outlets in the workers’ comp industry have covered these updates surrounding topical medications, including WorkCompCentral, who reached out to various industry professionals, including Healthesystems’ clinical experts.

Chief Medical Officer, Robert Goldberg, MD, FACOEM, discussed this shift in utilization and spend, stating that compound drug denials have lowered drug sales for certain entities, leading to a new focus in pushing private-labeled topicals to patients, despite high costs and a lack of clinical necessity. Meanwhile, Healthesystems Clinical Pharmacist, Dr. Regina Mears, noted that the results from the Annals of Internal Medicine confirmed what the Healthesystems clinical team has long continued to research, track, and manage via various compound utilization and cost management initiatives.

Healthesystems has also reported on topicals in the page of RxInformer journal, addressing common myths surrounding private-labeled topicals, such as the belief that they are FDA-approved or superior to over-the-counter products, and the differences between private-labeled topicals and topical compounds.

Topical products, be they compounds or private-label products, should be investigated whenever found in a workers’ comp claim, as they do not offer any clinical advantages and serve to inflate claim costs.

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