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:

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.