Ibuprofen is now the most commonly prescribed drug in California workers’ compensation cases.
Ibuprofen most prescribed drug in California: According to new data, the types of drugs used to treat injured workers in California, as well as the distribution of payments for those medications, have shifted over the last decade, with opioids becoming far less common and anti-inflammatory drugs accounting for an increasing share of prescriptions and total drug spend within the workers’ compensation system.
Based on the volume of prescriptions and overall reimbursements, the California Workers‘ Compensation Institute has updated its list of the top 10 therapeutic drug categories in the state’s workers’ compensation system.
Analysts at the CWCI studied drug distributions from 2012 to 2021 to see how the mix of prescription pharmaceuticals and drug payments in the system changed over the last decade. They drew attention to more current prescription drug usage and reimbursement trends.
The findings show that NSAIDs, which are commonly used as non-narcotic pain relievers, surpassed opioids to become the most commonly prescribed workers’ compensation drug group in 2016, and that by 2021, these alternatives would account for a record 34.0 percent of all prescriptions written for injured workers in California.
Last year, opioid prescriptions accounted for 10.2% of all workers’ compensation prescriptions. According to CWCI, the majority of the drop in opioid use over the last decade occurred between 2012 and 2019, with the opioid percentage of prescriptions remaining relatively consistent over the last three years, just dipping down slightly from 11.7 percent to 10.2 percent.
The top five most prescribed drug classes in 2021 were anticonvulsants, dermatological, and antidepressants. Anticonvulsants and dermatological, like NSAIDs, are frequently used to treat pain, and their share of workers’ compensation prescriptions has risen over the last decade, while antidepressants’ share, which ranged between 5.2 percent and 6.6 percent from 2012 to 2019, climbed to a record 8.0 percent in 2021 – the pandemic’s second year, according to the data.
Following the state’s installation of a workers’ comp formulary in 2017, musculoskeletal medications fell from 10.6% of all workers’ comp prescriptions in 2016 to 6.0 percent of prescriptions last year. According to CWCI, the formulary makes most musculoskeletal medicine prescriptions subject to utilization review, with a few exceptions where they are approved as special fill or perioperative drugs.
The top 10 therapeutic drug classes accounted for 77.9% of overall drug spending in 2021, according to CWCI analysts, down from 80.2 percent in 2012, when opioids devoured 26.2 percent of prescription dollars (vs. 5.8 percent last year), and ulcer drugs accounted for 10.3 percent (vs. 6.3 percent in 2021). According to the institute’s data, NSAIDs’ proportion of prescription expenditures increased from 13.4 percent in 2012 to 25.0 percent in 2021, dermatological medications increased from 12.9 percent to 17.2 percent, and anticonvulsants increased from 4.9 percent to 8.6 percent.
Several other drug groups (psychotherapeutic and neurological drugs, anticoagulants, and antidiabetic drugs), which each represented only 0.3 percent of prescription dollars a decade ago, are now among the top ten most expensive drug groups, accounting for between 2.6 percent and 2.9 percent of total payments, according to the 2021 data. In 2021, combined payments for these pharmaceuticals, which accounted for only 0.9 percent of overall prescription drug costs a decade before, amounted to 8.1 percent of total drug spending.
Ibuprofen and naproxen accounted for over two-thirds of all NSAIDs prescribed last year, with average costs of $12 and $47, respectively, making them comparatively inexpensive.
However, the CWCI discovered that NSAIDs were the most expensive medicine category in 2020 due to two low-volume, high-priced NSAIDs, fenoprofen calcium and ketoprofen. CWCI highlighted in a March 2021 study that both of these prescriptions are immune from prospective utilization review under the formulary, and neither has a Federal Upper Limit, which would function as a price restriction in California workers’ comp because they are not listed in the national Medicaid database.
Instead, depending on manufacturer pricing, the medications are paid at 85 percent of the average wholesale price. According to CWCI, the impact of this may be seen in average payment statistics from 2021, with an average payment of $1,487 for a fenoprofen calcium prescription and $1,073 for a ketoprofen prescription.
That means that fenoprofen calcium, which accounted for 0.5 percent of all workers’ compensation prescriptions in 2021, accounted for 9.2 percent of total drug spending, far exceeding any other single drug, while ketoprofen, which accounted for 0.2 percent of prescriptions, accounted for 3.0 percent of total drug spend.
Author: Muhammad Asim