Prescription drugs

CWCI notes changes to mix of prescription drugs and payments for California workers

CWCI notes changes to mix of prescription drugs and payments for California workers

  • 09/06/22

Oakland, Calif. ( – New data from the California Workers’ Compensation Institute (CWCI) shows that the types of drugs used to treat injured workers in California and the distribution of payments for those drugs have changed dramatically over the last decade. , with opioids becoming much less prevalent and anti-inflammatories (NSAIDs) accounting for a growing share of prescriptions and total drug spending within the workers’ compensation system.

Updated numbers from the CWCI’s interactive prescription drug app rank the top 10 therapeutic drug categories in the makeup of California workers based on prescription volume and total reimbursements. Comparing dispensed drug distributions from 2012 to 2021, CWCI analysts have tracked how the mix of prescription drugs and drug payments has changed in the system over the past decade and noted more recent trends in regarding the use and reimbursement of prescription drugs.

The results show that NSAIDs, often used as non-narcotic alternatives to treat pain, overtook opioids to become the top group of drugs against workers in 2016, and in 2021 they reached a record high of 34.0% of orders issued to injured workers in California. . Breaking down prescriptions by drug ingredient revealed that most of the growth in NSAIDs over the past decade was due to the increased use of inexpensive ibuprofen, which rose from 27.0% of all anti- in 2012 to 41.2% of NSAIDs dispensed in 2021. As a result, ibuprofen is now the most commonly used drug in workers’ compensation, accounting for 14.1% of all prescriptions dispensed last year, ranking well ahead of another NSAID, naproxen, which ranked second, accounting for 8.3% of prescriptions dispensed to injured workers. Meanwhile, the share of opioids in workers’ prescriptions continued to decline, falling to 10.2% last year, although most of the decline in opioid use over the past decade is produced between 2012 and 2019, with the share of opioids in prescriptions remaining relatively stable over the past decade. over the last 3 years, declining only slightly from 11.7% to 10.2%.

Consistent with 2020, anticonvulsants, dermatologics, and antidepressants round out the five most prescribed drug groups in 2021. Like NSAIDs, anticonvulsants and dermatologics are often used to treat pain, and their share of worker prescriptions has increased over the past decade. , while the share of antidepressants, which varied between 5.2% and 6.6% from 2012 to 2019, reached a record 8.0% in 2021 – the second year of the pandemic. On the other hand, musculoskeletal drugs fell from 10.6% of all workers’ compensation orders in 2016 to 6.0% of orders last year, a drop that followed the implementation by the state of a workers’ compensation form in 2017. The form made most prescriptions for musculoskeletal drugs subject to use review, with limited exceptions where they are permitted as special filler drugs or perioperative. Ulcer drugs, typically used to treat digestive problems associated with opioids and NSAIDs, were the only other therapeutic drug group that accounted for at least 5% of prescriptions last year, although their share fell to a low 10-year decline of 5.6% in 2021, a downward trend that follows the decline in opioid use over the past decade.

Ranking the top therapeutic drug groups based on total payments, CWCI analysts found that the top 10 groups combined accounted for 77.9% of total drug spending in 2021, up from 80.2% in 2012, when opioids consumed 26.2% of prescription dollars (vs. 5.8% last year) and ulcer drugs 10.3% (vs. 6.3% in 2021). With declining opioid payments, NSAIDs share of prescription dollars increased from 13.4% in 2012 to 25.0% in 2021, dermatology drugs increased from 12.9% to 17.2 % and the share of anticonvulsants increased from 4.9% to 8.6%. The 2021 data also shows that several other groups of drugs (psychotherapeutic and neurological drugs, blood thinners and antidiabetics) that a decade ago each accounted for only 0.3% of prescription dollars, are now among the 10 groups. of the most expensive drugs, each representing between 2.6% and 2.9% of total payments. Thus, the combined payments for these drugs, which a decade ago represented only 0.9% of prescription drug costs, represented 8.1% of total drug expenditure in 2021.

Although ibuprofen and naproxen accounted for nearly two-thirds of all NSAIDs dispensed last year, average payments for these drugs were $12 and $47, respectively, so they were relatively inexpensive. However, the Institute found that, similar to 2020, two low-volume, high-priced NSAIDs, fenoprofen calcium and ketoprofen, made NSAIDs the most expensive drug category. In a March 2021 study, CWCI noted that under the formulary, these two drugs are exempt from prospective use review and because they are not listed in the national Medicaid database, neither are listed. There is an upper federal limit, which would serve as a price control in California. comp. Instead, they are reimbursed at 85% of the average wholesale price, which is based on manufacturer prices. The impact of this can be seen in the 2021 average payment data, as the average payment for a fenoprofen calcium prescription was $1,487 and the average payment for a ketoprofen prescription was $1,073. For example, fenoprofen calcium, which represented only 0.5% of all worker drug prescriptions in 2021, accounted for 9.2% of total drug expenditure, by far the highest percentage of all drugs, while ketoprofen, which accounted for only 0.2% of prescriptions, ranked fourth, accounting for 3.0% of total drug spending.


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Joan J. Dean

The author Joan J. Dean