Injured workers’ prescriptions filled outside pharmacy networks cost an average of 67% more than comparable in-network medications, according to an analysis released Friday by Enlyte.
The report analyzed calendar-year 2025 retail pharmacy, mail-order and paper medical bill prescription transactions across workers compensation and auto casualty claims, comparing utilization and spending between in-network and out-of-network channels to provide a broader picture of pharmacy costs.
The report found the largest price disparities among muscle relaxants, which cost 69% more when dispensed out of network, and topical medications, which averaged 62% higher costs. Even commonly prescribed nonsteroidal anti-inflammatory drugs and opioids were 35% to 38% more expensive when filled outside pharmacy networks.
While opioids remained the largest therapeutic class by spend and prescription volume within Enlyte’s in-network pharmacy program, the out-of-network market looked markedly different. Topical medications accounted for the largest share of out-of-network spending, followed by NSAIDs, muscle relaxants, anticonvulsants and gastrointestinal agents, suggesting physician-dispensed creams and other high-cost topical products continue to drive pharmacy spending outside traditional networks. In-network, the leading therapeutic classes by spend included opioids, respiratory medications, anticonvulsants, dermatologicals and topical preparations.
Florida, Illinois, New York, Pennsylvania and Tennessee represented the highest pharmacy spending in the dataset, with costs per script and percentage of out-of-network spending varying. Enlyte attributed much of the variation to state rules governing physician dispensing and pharmacy direction of care that influence network participation and prescription cost controls.
New York emerged as an exception to the broader national trend. Unlike most jurisdictions, in-network prescriptions there carried higher average costs than out-of-network fills because some prescribers selected higher-priced versions of drugs included on the state’s workers compensation formulary. According to the report, those products can bypass prior authorization and clinical review despite remaining formulary-compliant. The report also noted that New York and Tennessee, which allow pharmacy direction of care, had relatively low out-of-network prescription volume — 17.6% and 8.8%, respectively —compared with states that permit physician dispensing.
This article was first published by Business Insurance.
