https://www.wcirb.com/sites/default/files/documents/ca_wc_medical_agg_paymenttrends_report_calendar_year_2017.pdf

California’s Workers’ Compensation Insurance Rating Bureau (WCIRB) released their California Workers’ Compensation Aggregate Medical Payment Trends report which compares medical payment information from 2015 to 2017. The data represents 92% of the state’s workers’ comp insurance market and medical payments totaling $2.1 billion.

There was a cumulative 8% reduction in medical payments per claim from 2015 to 2017

They found significant declines in the average paid per transaction in pharmaceutical (24%), pharmacy (28%) and pharmacist (27%) categories since 2015, which they attribute to reductions in prescriptions of controlled substances and physician dispensing as well as the overall shift towards generic drug use. The implementation of Federal Upper Limits also may have contributed to the decrease, but these reductions are not a result of a new drug formulary as that was only implemented in January of 2018.

The share of workers’ compensation claims with any opioid prescriptions fell from 18.2% to 11.6% in 2017. On average, medical payments on claims with at least one opioid prescription were more than three times higher than those on claims with no opioids.

There was a change in the mix of Medical-Legal (ML) services in 2017, the most comprehensive and expensive service transactions (ML104) declined by 22.7% but the share for the most basic ML evaluations (ML102) increased by 42.6%. There was an 8% decline in the average cost of a ML report in 2017 after years of increases.

Read more from WCIRB and read the full report here.