Report: Cost of Prescriptions in Workers’ Comp on The Rise

While overall utilization is trending downward, cost of prescriptions in workers’ compensation is on the rise, driven by “high-dollar topical agents” that primarily come from out-of-network channels, as well as increased utilization and spend on migraine medicines, and rising trends in average wholesale price for certain drug products.

Those findings are from Part 2 of Enlyte’s 2024 Annual Pharmacy Solutions Drug Trends Report, Evaluating In-Network and Out-Of-Network Trends. Each year Enlyte researchers analyze drug utilization and spending trends in workers’ comp. Part 1 of the report’s findings included that overall opioid utilization was down nearly 10%, and the use of sustained-release opioids dropped by more than 10%.

The second part of the report shows prescriptions per claim were down 3.7%, costs per prescription were up 7.3% and cost per claims was down 3.3%.

The top 10 therapeutic classes by cost were:

1. Topicals
2. Opioids
3. Anticonvulsants
4. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
5. Muscle Relaxants
6. Respiratory Medications
7. Antiulcer Medications
8. Antidepressants, Non-TCA
9. Migraine Medications
10. Hematological Medications

The study shows eight of the top 10 therapeutic classes saw decreased utilization per claim in 2023, with four of those classes falling by more than 5%. The largest usage increase was migration medications at 15%, and the largest decrease were opioids at 10.1%.

Cost per prescription rose in all 10 of the top therapeutic classes, with the largest increase in antiulcer medications at 15.9%, followed by a 10.5% increase in hematological medications and a 9.9% increase in migraine medications. The cost per claim for migraine medications jumped by 26.4%, driven by increases in utilization and cost per prescription, the report shows.

San Diego, California-based Enlyte is the parent company of Mitchell, Genex and Coventry, a provider of cost-containment technology, independent medical exams, provider and specialty networks, case management services, pharmacy benefit and disability management.