Research Shows Low-Volume/High-Cost Meds in California Workers’ Comp

New research on low-volume/high-cost drugs used to treat injured workers in California spotlights a handful of anti-inflammatory and anticonvulsant medications that have become significant cost drivers despite accounting for a relatively small share of the prescriptions within their therapeutic drug groups.

The research from the California Workers’ Compensation Institute is the first of a three-part series that uses data from the CWCI’s Prescription Drug Application to track changes in the distribution of California workers’ comp prescriptions and prescription payments over the past decade, and to identify medications with high average reimbursements that have an outsized impact on the total payments within their drug group.

Among the key findings for the anti-inflammatory and anticonvulsant drugs:

• Ibuprofen and naproxen represented two-thirds of the anti-inflammatories dispensed in 2021, but with average payments of $12 and $49 respectively, they were relatively cheap. Meaning it was low-volume, high-cost fenoprofen calcium (with an average payment of $1,479), and ketoprofen (with an average payment of $1,073) that kept anti-inflammatories at the top of the list in terms of total drug spend.
• Fenoprofen calcium represented 1.4% of the 2021 anti-inflammatory prescriptions but 33.2% of the payments, while ketoprofen represented 0.6% of the prescriptions but 9.8% of the payments.
• Fenoprofen calcium represented just 0.5% of all workers’ comp prescriptions in 2021, but 8.1% of the total drug spend within the system. That was by far the largest percentage of any single drug.

CWCI has published the first part of its study in a Spotlight Report, Cost-Driver Medications in the Top California Workers’ Comp Drug Groups: Part 1, Anti-Inflammatories & Anticonvulsants. Institute members and subscribers can log on to the Institute’s website to access the report under in the Research section, others can purchase a copy from the Institute’s online store.

CWCI research on low-volume/high-cost medications will continue with Part II in the series, which will focus on medications found in the dermatological, opioid, and antidepressant drug categories, while part iii will highlight low-volume/high-cost musculoskeletal and ulcer drugs.

Related:

• Report: California Workers’ Comp Public Self-Insured Claim Volume Rose in FY 2021/22
• California Workers’ Comp Benefits to Increase in 2023
• California Workers’ Comp Independent Medical Review Volume Fell in First Half of 2022

Topics California Workers' Compensation