Dermatological Agents Continue to Increase as Opioids Decline for Workplace Injuries, Finds New WCRI Study

Cambridge,MA (WorkersCompensation.com) ― A new FlashReport from the Workers Compensation Research Institute (WCRI) finds that in several states, payments for dermatological agents continued to increase, driven by increased dispensing of higher-priced drug products either from physicians’ offices or from mail-order pharmacies.

“This study finds that payment shares for opioids continued to decrease in almost all state workers’ compensation systems, but a substantial increase in dispensing of dermatological agents was seen in several states,” said John Ruser, president and CEO of WCRI. “This study breaks prescription drugs into groups (dermatological agents, nonsteriodal anti-inflammatory drugs [NSAIDs], opioids, compounds, etc.) so you can see where workers’ compensation prescribing dollars are being spent and whether spending for those groups of drugs is going up or down.”

The FlashReport, Interstate Variation and Trends in Workers’ Compensation Drug Payments: 2018Q1 to 2021Q1, examines state trends in payments for prescription drugs within workers’ compensation for non-COVID-19 claims from the first quarter of 2018 (2018Q1) to the first quarter of 2021 (2021Q1). The study focuses on the share of all prescription payments (“payment share”) in a particular quarter accounted for by various drug groups, and the quarterly payment for each drug group per claim with prescriptions (“per-claim payment”).

The following is an abbreviated list of the study’s other findings:

• Dermatological agents: There was substantial interstate variation in per-claim payments for dermatological agents in 2021Q1, from $10 per claim in Minnesota to $312 per claim in Pennsylvania. Payment shares for this drug group increased by at least 10 percentage points in seven states. Physician dispensing of dermatological agents contributed to the rapid growth in Connecticut, Florida, Georgia, and Michigan; and increases in higher-priced drug products dispensed from certain pharmacies were seen in Louisiana, Pennsylvania, and South Carolina.
• NSAIDs: The quarterly payments per claim varied widely across states in 2021Q1, from $21 per claim in Massachusetts and Minnesota to $129 per claim in Florida. California saw a large increase in payment share and per-claim payments for NSAIDs, driven by a relatively small number of prescriptions for certain drugs at a much higher price.
• Anticonvulsants: Both payment shares and per-claim payments for this group decreased in many states over the study period due to the introduction of the generic form of Lyrica®. The 28-state median of payment shares for anticonvulsants decreased from 14–15 percent in 2018 to 10–11 percent in the latest quarters.
• Opioids: Despite the continuing decrease in opioid dispensing, there was still large variation in payments per claim for opioids across states. In 2021Q1, the per-claim payment for opioids was $54 in Louisiana, nearly double the second highest state and more than three times the 28-state median. On the lower end, the per-claim payment for opioids was $3 in California.

In the previous edition of this report, we provided an early look at the impact of COVID-19 on prescription drug payments and found that per-claim payments and the amount of opioids increased at the start of the COVID-19 pandemic primarily due to a shift in the claim maturity towards longer-maturity claims. With one more year of data, we see that the shift in claim maturity peaked in 2020Q2, largely due to the initial shock of the COVID-19 pandemic. The average claim maturity decreased in the following quarters, and as a result, per-claim payments for all prescriptions and opioids decreased in general from the level observed in 2020Q2. The average claim maturity decreased after 2020Q2 although it was still higher in 2021Q1 in some states compared with the level of maturity at the beginning of the study period (2018Q1).  

The 28 states in the study are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. In each quarter, prescriptions that were dispensed for all medical claims with injuries occurring within three years of the prescription fill date and paid under workers’ compensation were included. The study focused on prescriptions for non-COVID-19 claims.

To learn more about this study or to purchase a copy, visit https://www.wcrinet.org/reports/interstate-variation-and-trends-in-workers-compensation-drug-payments-2018q1-to-2021q1a-wcri-flashreport. The authors of this study are Dr. Vennela Thumula, Te-Chun Liu, and Dongchun Wang.

About WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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