Nonsteroidal anti-inflammatories now account for more than a third of all drugs dispensed to injured workers, and just two NSAIDs account for two-thirds of prescription payments in that drug category, according to a report released Wednesday by the California Workers Compensation Institute.
Oakland, California-based CWCI analyzed changes in the distribution of workers comp prescriptions and prescription payments in the state over the past decade, finding that opioid prescriptions have dropped 62% since 2011, while NSAIDs rose to become the No. 1 drug group prescribed in 2015 and continue to hold that position.
NSAIDs accounted for nearly 24% of total drug expenditures in 2020, compared with 14% in 2018, when the state’s drug formulary took effect.
While more than two-thirds of all NSAIDs were prescriptions of ibuprofen and naproxen, the sharp increase was due to payments for two high-priced drugs — fenoprofen calcium and ketoprofen — which are used to treat arthritis and pain and are exempt from prospective utilization review, according to the report.
The average amount paid for a prescription of fenoprofen calcium totaled $1,479 in 2020 — a 636% increase over the average charge in 2016, accounting for more than a quarter of NSAID drug expenditures in 2020 despite representing just 1% of prescriptions. The average amount paid for ketoprofen in 2020 was $1,097, up 10-fold from $99 in 2016.
Under the terms of the state’s fee schedule, prescriptions for unlisted drugs are paid at 83% of their average wholesale price set by drug manufacturers.
Opioids remained the second most prescribed category of drugs in 2020, but the drug’s share of prescription payments fell from 30.7% in 2011 to 7% in 2020. That ranked the drug group fourth in terms of total drug spend behind NSAIDs (23.5%), dermatological drugs (14.1%) and anticonvulsants (13.1%).
Prescriptions of muscle relaxants, which had been the third most heavily prescribed workers compensation drug group prior to the adoption of the formulary, dropped sharply between 2018 and 2020, as drugs in that category are subject to utilization review.
This article was first published in Business Insurance.