Prescriptions for opioids and compounds continue to decline in workers compensation, but dermatologicals — particularly physician-dispensed drugs — continue to be a cost driver, according to the Workers Compensation Research Institute.
Preliminary data from 28 states showed that the payment share of dermatologicals increased from 11% in 2015 to 21% in the first quarter of 2020, while opioids’ payment share fell during that same period from 21% to 8%. Cambridge, Massachusetts-based WCRI presented the research Tuesday at its virtual Annual Issues and Research Conference.
“Compounds, which were once a prominent cost driver of prescription drugs, also decreased substantially,” said Vennela Thumula, policy analyst for WCRI, who noted that compounds’ payment share dropped from 10% in 2015 to 2% in the first quarter of 2020.
While the increase in drug expenditures for dermatologicals varied substantially among the states studied, those with high levels of dermatological drug expenditures also generally saw more of these drugs dispensed by physicians rather than pharmacies, she said.
For example, the percentage of prescription payments for dermatologicals topped 40% in South Carolina, but only made up 4% of payments in Iowa, where all of the dermatologicals were pharmacy dispensed. In South Carolina, as well as Georgia, Illinois and Maryland, about three quarters of dermatological drugs were physician-dispensed, according to early WCRI research.
In the dermatological category, prescriptions for diclofenac sodium gel accounted for the majority of the prescriptions in the median state, Ms. Thumula said, and lidocaine was also commonly prescribed.
While about 56% of the workers prescribed topical diclofenac had documented diagnoses of soft tissue injuries of joints — for which the drug is approved — about 40% of workers were using it for treatment not recommended, often for shoulder and back pain, she said.
Another cost driver in dermatologicals is private-label topicals, which are independently manufactured and not recommended by evidence-based guidelines and “also have a much higher price tag compared to comparable products” approved by the Official Disability Guidelines Workers’ Compensation Drug Formulary, also known as ODG, Ms. Thumula said.
“Among claims with topicals, private-label topicals are rarely dispensed in half of the study states, but at least a third of the claims have private-label topicals in Louisiana, New Mexico, Maryland, Illinois and South Carolina, and it’s even higher in Delaware,” she said.
This article was first published in Business Insurance.