NSAID Use Surpasses Opioids for Injured California Workers

Non-steroidal anti-inflammatory drugs (NSAIDs) have surpassed opioids as the most common therapeutic drug group for injured workers in California, according to a new study.

In addition, studied payment data show that both dermatological medications and anticonvulsants rank ahead of opioids in terms of total reimbursements.¹

By examining 5.75 million filled prescriptions for California workers, from 2009 to June 2018, investigators at the California Workers’ Compensation Institute (CWCI) calculated average paid amounts for items in each drug group, charted changes in payment and prescription distributions, and identified trends.²

Investigators found that, because of rigorous efforts to reduce opioid use, opioids fell to 18% of filled prescriptions in the first half of 2018, as opposed to 30.5% in 2008.¹ This control was completed through independent medical and utilization reviews, medical provider networks, in the Medical Treatment Utilization Schedule (MTUS) formulary, pharmacy benefit managers, and restrictions by payers, as well as a growing public awareness.

NSAIDs became the top drug group for California worker’s compensation in 2016, and climbed to 31.7% of the drugs dispensed to injured workers in 2018.

Meanwhile, anticonvulsant use more than doubled from 4.1% in 2009 to 9.7% in the first half of 2018.²

Anticonvulsants were the third most popular group, moving past muscle relaxants, according to the 2018 data.²

The CWCI study has also found changes in the prescription payment distribution, as the proportion for dermatological products increased from its previous point of 10.1% to 17.6% in 2018, becoming the top drug group in terms of total payments. Until a few years ago, this growth was largely the result of high-cost "custom" pharmacy compounded drugs. However, over the past 2 decades, custom compounds are less prevalent, because of changes in public policy, greater public awareness, and incidents with compounding drug kickbacks.¹

Factors such as an increased prevalence of high-cost, mass-produced private-label topicals commonly found in OTC topical analgesics and increased payments for accessible topicals containing prescription NSAIDs were also cited as having a substantial impact on the growth of dermatological payments.

Anticonvulsants' share of the drug spend was also found to have tripled, to 15.2% in 2018, from 4.8% in 2009. These drugs now rank above opioids as the second most costly drug group, growth that coincides with the opioid use decline. The anticonvulsants' prescriptions in California workers compensation mainly focus on 2 drugs, which includes 1 brand drug that accounted for three-quarters of the anticonvulsant dollars paid in the first half of 2018.

References

• California workers’ compensation prescription drug utilization & payment distributions, 2009-2018: part 1. California Workers’ Compensation Institute website. cwci.org/document.php?file=4190.pdf. Published February 15, 2019. Accessed Feb. 15, 2019.
• NSAIDs overtake opioids as the top workers’ comp drug group; dermatologicals are most costly [news release]. Oakland, California; February 15, 2019: California Workers’ Compensation Institute website. businesswire.com/news/home/20190215005531/en. Accessed Feb. 15, 2019.