The Workers’ Compensation Research Institute (WCRI) published the fifth edition of their report on interstate variation and trends in workers’ comp drug payments.
This report reviews the changing costs of prescription drug payments up through Q1 of 2023 in 28 states, categorizing drugs into seven key groups, including:
- Dermatological agents
- NSAIDs
- Opioids
- Anticonvulsants
- Musculoskeletal therapy agents
- Antidepressants
- Compound drugs
Overall, prescription payments per medical claim continued to decline significantly in most states. Massachusetts saw the largest decline at 68%, while Louisiana saw an increase in payments of 22% and Pennsylvania saw a 16% increase. During Q1 of 2023, average quarterly prescription payments per medical claim was $7 in Massachusetts and $274 in Louisiana.
In a median of 28 states, dermatological agents made up 22% of total prescription payments in Q1 of 2023 – the largest share of payments – with NSAIDs coming in at second with an 18% share of payments. Musculoskeletal agents and anticonvulsants both made up 9% of payments respectively.
Payment shares for dermatological agents have plateaued or decreased for most states, however in 12 states they still made up 30% of prescription payments. Five states – Connecticut, Georgia, Louisiana, Pennsylvania, and Virginia – saw dermatological agents make up 44-55% of prescription payments.
Payment shares for NSAIDs have remained relatively stable. California saw significant decreases due to rule changes surrounding ketoprofen and fenoprofen. However, per-claim payments for NSAIDs increased 34% in New York from Q1 of 2021 to Q3 of 2023. This was due to greater dispensing of higher-priced diclofenac potassium 25 mg tablets. These drugs made up 31% of NSAID payments in New York and were not seen commonly in other states.
Payment shares for anticonvulsants decreased 14% since 2018, due to the availability of generic Lyrica®.
Payment shares for musculoskeletal agents had very minor fluctuations across states, with few exceptions. California and New York saw per-claim payments decrease 22-33%, while Louisiana and Pennsylvania saw 74% and 59% increases respectively.
Opioid prescribing continued to decline in most states, with per-claim spending decreasing by 24-51% in 22 states from Q1 of 2021 to Q3 of 2023. However, there still remains wide variation in opioid payments per claim across different states, with a low of $2 in California and a high of $33 in Louisiana.
Of note, migraine medications accounted for 7-15% of prescription payments in the top quartile of states as of 2023. Per-claim payments for migraine medications increased in 23 of the 28 study states, and in the 28-state median, migraine medications made up 3% of prescription payments.
