A study out from The California Workers’ Compensation Institute study reveals that non-steroidal anti-inflammatories (NSAIDs) have surpassed opioids as the most common therapeutic drug group that is prescribed to injured workers in California. They have been the top drug group since 2016 and their share of prescriptions is continuing to grow. In the first half of 2018 they represented 31.7 percent of drugs dispensed to injured workers.

Looking at data from 5.75 million prescriptions dispensed to California injured workers from 2009 to 2018, they examined changes in the prescription and payment distributions among therapeutic drug groups, identified generic use trends and determined the average amounts paid for each drug group over the study period.

Efforts to curb inappropriate use of opioids have worked, as opioids fell from 20.2 percent of prescriptions filled in the first half of 2018 in 2017 to 18 percent in the first half of 2018. A decade ago they were 30.5 percent of prescriptions filled. The authors of the study point to 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.

They also found that payment data shows both dermatological medications and anticonvulsants now rank ahead of opioids in terms of total reimbursements. Anticonvulsants’ share of prescriptions increased from 4.1 percent in 2009 to 9.7 percent in the first half of 2018. Researchers say this may be due to their use as a non-opioid alternative for neuropathic pain treatment, and they were the third more prescribed drug group.

They found shifts in the distribution of prescription payments too. A decade ago dermatological products made up 10.1 percent of the total drug spend and were the fourth most costly drug group. In the first half of 2018 they made up 17.6 percent of prescription payments and were the top group in terms of total payments.

Anticonvulsants also increased in drug spend, accounting for 4.8 percent of spend in 2009 to 15.2 percent in the first half of 2018. They are the second most costly group. Most of the growth for anticonvulsants occurred in the past four year which coincides with the decline in opioids, which researchers say may suggest that anticonvulsants are being used instead of opioids. These prescriptions are concentrated in just two specific drugs, one of which is available only as a brand name drug. That accounted for almost three-fourths of the anticonvulsant dollars paid in the first half of 2018.

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