July 2, 2020

WCRI Reports on Interstate Variation Trends in Drug Payments

The Workers’ Compensation Research Institute (WCRI) published a new Flash Report on interstate variation and trends in workers’ comp drug payments from Q1 of 2016 to Q1 of 2019.

This report presents data from 28 states on quarterly payments of prescription drug groups including:

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

At 22 pages, this report contains various insights, but key among them were insights related to dermatological agents, which have seen increased utilization.

In most states, dermatological agents and NSAIDs have become more important than other drug groups as a share of total prescription payments. In the median of the 28 study states, both dermatological agents and NSAIDs accounted for 18% of total prescription payments in Q1 of 2019, with payment shares varying widely between states.

Dermatological agents saw substantial interstate variation in per-claim payment, ranging from $7 per claim in Iowa to $192 per claim in Illinois in Q1 of 2019. Payment shares increased by more than 3% in 20 states and more than 10% in nine states. Furthermore, a rapid increase in average payment per claim with a prescription for dermatological agents was seen in six states, with a 28-state median averaging an increase of 22%.

This increase was greatest in Texas at 44%, while in Connecticut, the per-claim payment of a claim with dermatological agents was three times higher in Q1 of 2019 than in Q1 of 2016. A doubling of per-claim payments across the same period was seen in five other states; Kansa, Louisiana, Massachusetts, South Carolina, and Virginia.

At 22 pages, more insights are contained throughout the report. Of note, opioid prescribing continued to decline in all 28 study states, with per-claim payments decreasing by 58% in the typical state. Rate of reduction ranged from 33% in Louisiana to 85% in California.

It is possible that a decrease in opioid utilization has led to an increase in the prescribing of other pain medication alternatives. Healthesystems recently published Growing Pains: The Shift from Opioids to Other Pain Therapies which explores how the utilization of other pain therapies has increased, while also examining concerns related to those opioid alternatives.

Other miscellaneous findings of the WCRI report include:

  • Quarterly payments per claim for NSAIDs varied widely, from $18 to $89 per claim, with a median of $40 per claim in Q1 of 2019. However, NSAID payment shares remained fairly stable over time
  • Anticonvulsants and musculoskeletal therapy agents saw stable trends in payments, with a handful of exceptions in certain states

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