A new study shows that nonsteroidal anti-inflammatories (NSAIDs) now account for more than one-third of all drugs dispensed to injured workers in California, triple the proportion for opioids.
A study from the California Workers’ Compensation Institute released on Wednesday also shows that although most NSAIDs that are used are inexpensive, and utilization has been flat since the state’s evidence-based prescription drug formulary took effect in 2018, NSAIDs’ share of the total drug spend has soared from 14.2% to 23.5%.
The surge was largely driven by increased payments for two low-volume, high-priced drugs that are exempt from prospective utilization review and that lack price controls, according to the CWCI study.
The CWCI examined the distribution of California workers’ compensation prescriptions and prescription payments over the past decade using data on 5.85 million prescriptions dispensed to injured workers, resulting in payments totaling $623 million.
The CWCI data shows opioids accounted for 11.6% of the prescriptions filled in the first half of 2020, down from 31.0% in 2011 – a decline of 62.6% during the study period.
NSAIDs, often considered non-opioid alternatives to treat pain, surpassed opioids as the number one drug group in 2015, and in both 2019 and the first half of 2020 they accounted for more than one-third of all prescriptions dispensed to injured workers, twice the proportion noted a decade earlier, according to the CWCI.
Ranking behind opioids in terms of utilization are anticonvulsants, dermatologicals, and antidepressants, which round out the top five drug groups. Musculoskeletal drugs, the third most heavily used workers’ comp drug group until the formulary took effect, saw their share of the prescriptions fall sharply beginning in 2018 as under the formulary they are subject to prospective UR, with the exception of special fill or perioperative uses, where the quantity of the drug that can be dispensed is limited, according to the CWCI.
While opioids still rank second in workers’ comp prescription volume, the study found their share of the prescription payments fell from 30.7% in 2011 to 7.0% in the first half of 2020, so they now rank fourth in terms of total drug spend, behind NSAIDs (23.5%), dermatological drugs (14.1%), and anticonvulsants (13.1%).
“NSAIDs have seen the biggest increase in their share of the total drug spend since the formulary took effect, as their share rose from 14.2% to 23.5% in less than two years, a relative increase of 65.5%, even though two inexpensive drugs, ibuprofen and naproxen, account for two-thirds of all NSAID prescriptions,” the study states.
The study pinpointed much of the recent growth in NSAID payments to two low-volume, extremely high-priced NSAIDs – fenoprofen calcium and ketoprofen. Both are used to treat arthritis and pain, and they are on the formulary’s “Exempt” drug list, so they are not subject to prospective UR, and neither is in the national Medicaid database, so they have no Federal Upper Limit – a maximum fee allowed under Medicaid.
Instead, these drugs are paid at 83% of their average wholesale price set by the drug manufacturers, according to the CWCI.
CWCI’s study was released in a research update report, “California Workers’ Compensation Prescription Drug Trends,” which is free to CWCI members and research subscribers, while others can order a copy for $22.
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