Dermatologicals, which include a number of high-priced, private label drugs, account for the biggest share of the total drug spend in the California workers’ compensation system, a new report shows.
Data from the California Workers’ Compensation Institute shows recent shifts in the types of drugs prescribed to injured workers in California, as well as in the distribution of payments for those medications. Anti-inflammatory drugs rank first in the number of prescriptions, but dermatologicals now for the biggest share of the total drug spend, according to the CWCI.
The CWCI’s Prescription Drug Interactive Application ranks the top 10 therapeutic drug groups in California workers’ comp based on the volume of prescriptions and total reimbursements.
Comparing the distributions of drugs dispensed to injured workers from 2016 through June 2024, CWCI analysts noted the shifts in prescription drug utilization and reimbursement among the drug groups, which suggests an association between the ongoing decline in opioid use with the state’s adoption of the Opioid and Pain Management Guidelines into the Medical Treatment Utilization Schedule (MTUS) in late 2017, and the implementation of the MTUS Formulary in 2018.
Historical data show that anti-inflammatories like ibuprofen and naproxen surpassed opioids to become the top drug group in 2016, and by 2021 they accounted for a record 35.3% of all prescriptions dispensed to California injured workers.
Most of the growth in anti-inflammatories was due to increased use of inexpensive ibuprofen, which rose from 32.9% of all anti-inflammatories in 2017 to 42.2% in 2021, at which point it stabilized. Ibuprofen remains the most heavily used drug in California workers’ comp, representing 14.1% of all prescriptions in 2023 and 13.7% in the first half of 2024, ranking ahead of naproxen, which ranks second with 8.2% of the 2023 prescriptions and 7.9% of the prescriptions from the first half of 2024, according to CWCI.
Opioids’ share of workers’ comp prescriptions fell to 7.9% in 2023 and 7.6% in the first six months of last year, about a third of its 22% share in 2016 and about a quarter of its record 30.8% share in 2010, according to CWCI.
Dermatological drugs are often used to treat pain, and with opioid use declining, their share of workers’ comp prescriptions grew from 4.9% in 2016 to 12.6% in the first half of 2024. Though many different dermatologicals are used to treat injured workers, the breakdown by drug ingredients shows most of that growth was due to the increased use of prescriptions containing lidocaine and/or diclofenac sodium, which together increased from 46% of the dermatological prescriptions in 2016 to 81.6% in the first half of 2024, the CWCI report shows.
A review of total payments by drug ingredient shows that from January through June of last year, the dermatological lidocaine (average payment $159: $216 brand, $151 generic) ranked first among all drugs in terms of the California workers’ comp total drug spend, accounting for 8.5% of all payments. That was more than twice the percentage for the anti-inflammatory naproxen, which ranked second with 4.2% of the prescription dollars, ahead of the anticonvulsant pregabalin, which ranked third with 4.1%, according to CWCI.
CWCI published additional details and lists of the top 10 California workers’ comp therapeutic drug groups based on prescription volume and payments from 2016 through June of 2024 in a bulletin, which is available to CWCI members and research subscribers under the Communications tab the institute’s website.
Topics California Workers' Compensation
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