Factors Driving Pharmacy Trends in Injured Worker Recovery
Originally published on WorkCompWire | May 27, 2025
Recent data shows a significant decline in historically problematic drug classes in workers’ compensation, particularly opioids, followed by muscle relaxants, benzodiazepines, sedatives, and central nervous system stimulants. While continued vigilance related to the use of these drug classes is necessary, attention must also shift to emerging trends to provide the best possible claims outcomes.
Dermatologicals have now surpassed opioids as the top driver of cost and utilization, making cost-effective prescribing strategies critical. Rising spend and use are also anticipated for certain high-cost, low-volume drugs such as specific non-steroidal anti-inflammatory drugs (NSAIDs), migraine agents, anticoagulants, private-label topicals, and other specialty drug classes.
When developing workers’ compensation pharmacy program strategies, it is important to monitor emerging developments that can impact cost and success rates. Some of the latest trends include the following issues.
Evolving Presumption Laws
Recent legislative developments at both the federal and state levels have expanded presumptive coverage to include certain cancers and post-traumatic stress disorder (PTSD) for specific occupational groups. With over 20 states currently enacting or proposing changes to their cancer presumption laws, there has been a surge in related claims, leading to higher demand for costly oncology medications that require special management and ongoing clinical monitoring. PTSD also requires extended use of medications like antidepressants and anxiolytics. With PTSD’s chronic nature, it too can cause prolonged treatment durations that increase pharmacy costs.
Emergence of Novel Medications
There is a slow, but developing, adoption of novel medications for common conditions that present in workers’ compensation claims, including the GLP-1 receptor agonists for weight loss. The relevance to workers’ compensation arises from scenarios where injury-related immobility leads to weight gain, potentially complicating recovery. Between 2021-2023, reports cite a 14% increase in dispensing of these drugs in workers’ compensation claims. While traditionally not covered for weight loss in workers’ compensation, there is a growing conversation about their potential benefit in facilitating recovery by addressing obesity-related complications.
The Popularity of Topicals
An uptick in physician dispensing of private label topicals, which include creams, gels, ointments, or patches, drive a disproportionate share of spend within the dermatological category of pharmaceuticals. Although they contain common over-the-counter components, many are marketed under unique brand names and require a prescription from physicians.
Regulation Dispensing Loopholes
State-specific regulation loopholes are incentivizing inconsistent prescribing behaviors, including the use of the high-cost, low-volume NSAIDs ketoprofen and fenoprofen. These medications, while infrequently prescribed, disproportionately impact total drug spending due to their elevated costs and lack of stringent regulatory controls. This can incentivize prescribing that may not offer additional clinical benefits compared to more affordable alternatives. For example the two drugs mentioned above are exempt from California’s Workers’ Compensation Formulary, preventing them from prospective utilization review.
A Surge in Biologic and Biosimilar Approvals
There has been an increase in drug approvals and expanded indications for biologics and biosimilars. These drugs treat various therapeutic areas relevant to conditions like arthritis that can be exacerbated by workplace injuries, cancers potentially linked to occupational exposures, and ophthalmological therapies for vision impairments resulting from workplace incidents. The medications are costly, reported to potentially cost up to 40 times the cost of traditional medicines, and use is increasing. As of late 2024, there are 109 biosimilar development programs enrolled in the FDA’s Biosimilar Biological Product Development Program, which is up from 101 in 2023.
Mental Health Treatment Challenges
Although a relatively low-volume claim, mental health conditions account for nearly one-third of workers’ compensation costs due to factors like prolonged length of treatment, an influx of medical interventions, and extended time away from work. The use of antidepressants, anxiolytics, and antipsychotics is prevalent in managing conditions like depression, anxiety, and PTSD among injured workers. Addressing the pharmaceutical costs of mental health in workers’ compensation requires a multifaceted approach, focusing on early intervention, consistent coverage policies, and integrated care strategies to ensure both cost-effectiveness and optimal patient outcomes.
With awareness of these trends, it is important clinically to shift towards a nuanced approach that ensures appropriate therapy in these areas. This includes monitoring medication adherence rates and providing disease state management that relies on multidisciplinary collaboration of claims stakeholders and evidenced-based protocols. This will help to ensure effective treatment and timely recovery.