A Reversal of the Opioid Trend in California

Medicare Set-Asides, Opioids, Rx/Pharmacy on May 15, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

In February, the California Workers’ Compensation Institute (CWCI) published a report that had some interesting findings regarding the use of prescription drugs. With respect to utilization, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen now rank above opioids as the most commonly prescribed medication class for workers’ compensation claimants. In terms of reimbursement, CWCI reported that anticonvulsants and dermatological products have surpassed opioids in terms of total dollars spent. 

In compiling its report, CWCI reviewed 57.5 million prescriptions that were dispensed to workers’ compensation claimants between 2009 and 2018. In evaluating such a large pool of prescription drug utilization data, CWCI’s goal was three-fold: (1) to identify changes in prescribing and payment distributions among therapeutic drug groups, (2) to quantify trends in the use of generic medications and (3) to determine average reimbursement for drugs within each therapeutic class during the decade in review.

Within the report’s study period of 2009 to 2018, the prevalence of anticonvulsants as treatment for workers’ compensation injuries more than doubled from 4.1% to 9.7%. Within the narrower time period of 2014 to 2018, CWCI noted significant growth for two drugs – pregabalin (Lyrica) and gabapentin – which coincided with the release of prescribing guidelines that expressed a preference for non-opioid analgesics. A few weeks ago, we reported on a growing trend of abuse in patients taking gabapentin, which is related to the increase in gabapentin utilization identified by CWCI.  Data from 2018 revealed that Lyrica accounted for 75% of the prescriptions in this drug class (gabapentinoids), while gabapentin accounted for 25%.

In 2016, NSAIDs surpassed opioids as the most commonly prescribed drug class for workers’ compensation. In that year, NSAIDs accounted for 27.6% of total prescriptions dispensed versus opioids, which accounted for 22.9%. Since then, the use of NSAIDs for injured workers has continued to climb, reaching 31.7% in the first six months of 2018. Between 2008 and 2018, the rate of opioid prescribing in this population fell from 30.5% to 18%.

Last, but certainly not least, in its report CWCI noted that dermatologic products account for 17.6% of total drug spend for injured workers, which makes this the most costly drug class in this population. During the time period reviewed, the total drug spend increased from 10.1% in 2008. It is noteworthy that this drug class continues to increase in terms of total cost despite efforts by legislators and payers to curb utilization of these compounds. You may recall a few weeks ago, we reported on the inclusion of compounded medications in Workers’ Compensation Medicare Set-Asides (WCMSAs).

Ultimately, we are hopeful that we will continue to see a measurable decline in opioid use nationwide as evidenced by the CWCI report, which will in turn have a positive impact on WCMSAs.