NSAIDs Overtake Opioids as Top Workers’ Comp Drug in California

Non-steroidal anti-inflammatories, or NSAIDs, have supplanted opioids as the most common therapeutic drug group prescribed to injured workers in California, according to a new California Workers’ Compensation Institute study.

The study also finds that payment data show that both dermatological medications and anticonvulsants now rank ahead of opioids in terms of total reimbursements.

The study uses data from 5.75 million prescriptions dispensed to California injured workers from 2009 to June 2018. CWCI analysts examined changes in the prescription and payment distributions among therapeutic drug groups, identified trends in the use of generics and determined average amounts paid for drugs within each drug group over the past decade.

The results show that efforts to curb inappropriate use of opioids are continuing to have an effect, as opioids fell to 18.0 percent of the prescriptions filled in the first half of 2018, down from 20.2 percent in 2017 and down from 30.5 percent a decade ago.

The study credits measures including tighter scrutiny via utilization review and independent medical review, restrictions by payers, medical provider networks, pharmacy benefit managers and in the Medical Treatment Utilization Schedule formulary.

NSAIDs, often prescribed as non-opioid alternatives to treat pain, surpassed opioids as the top drug group in California workers’ comp in 2016, and since then, their share of the prescriptions has continued to grow, climbing to a record 31.7 percent of the drugs dispensed to injured workers in the first half of 2018, according to the CWCI study.

Anticonvulsants’ share of the prescriptions also increased, more than doubling from 4.1 percent in 2009 to 9.7 percent in the first half of 2018, likely due to their growing use as a non-opioid alternative to treat neuropathic pain, the study states.

The 2018 data show anticonvulsants were the third most prescribed drug group, moving ahead of muscle relaxants, which under the MTUS formulary that took effect on Jan. 1, 2018, are not exempt from utilization review, with the exception of limited special fill or perioperative allowances that restrict the quantity of the drug that can be dispensed.

The study also found shifts in the distribution of prescription payments.

A decade ago, dermatological products accounted for 10.1 percent of the total drug spend in California workers’ comp, and were the fourth most costly drug group behind opioids, NSAIDs and ulcer drugs.

In the first half of 2018, however, that proportion was up to 17.6 percent, making dermatologicals the top drug group in terms of total payments, according to the study.

In addition to the increasing share of the workers’ compensation prescription dollars going toward dermatologicals, the study also found that anticonvulsants’ share of the drug spend tripled from 4.8 percent in 2009 to 15.2 percent in the first half of 2018, so anticonvulsants now rank ahead of opioids as the second most costly drug group.

The data show that most of the growth in anticonvulsant’s share of the payments occurred over the past four years, coinciding with the decline in opioid use, suggesting the use of certain anticonvulsants in place of opioids. Notably, anticonvulsant prescriptions used in California workers’ comp are heavily concentrated in just two drugs, one of which is only available as a brand drug, and that drug accounted for nearly three quarters of the anticonvulsant dollars paid in the first half of 2018.

CWCI has published its study in a Research Update report, “California Workers’ Comp Prescription Drug Utilization and Payment Distributions, 2009-2018: Part 1.” The free report can be downloaded from the Research section at www.cwci.org.