A new FlashReport from the Workers Compensation Research Institute finds that in most states, dermatological agents and nonsteroidal anti-inflammatory drugs (NSAIDs) have become more important than other drug groups as a share of total prescription payments.

In the typical state, dermatological agents and NSAIDs each accounted for about 20 percent of total prescription payments in the first quarter of 2020, according to the WCRI study results released May 25.

“This study finds that prescription payments are decreasing in a majority of state workers’ compensation systems, but prescription payments continue to vary widely,” said John Ruser, president and CEO of WCRI. “This study breaks prescription drugs into groups (dermatological agents, NSAIDs, opioids, compounds, etc.) so you can see where workers’ compensation prescribing dollars are being spent and whether spending for those groups of drugs is going up or down.”

According to the FlashReport, Interstate Variation and Trends in Workers’ Compensation Drug Payments: Q1 2017 to Q1 2020, prescription payments per medical claim decreased by 15 percent or more in 20 of the 28 states over the study period. As of Q1 2020, per claim payments in the highest state were more than eight times higher than in the lower state. While focused primarily on the time before Covid-19, the study also provides data at a high level on the impact of Covid-19 on prescription drug payments and opioids during the first quarter of the pandemic.

The following is an abbreviated list of the study’s other findings:

Dermatological agents: Per-claim payments varied widely, from $7 per claim in Iowa to $181 per claim in Illinois and $190 per claim in Louisiana in Q1 2020. Physician dispensing accounted for the majority of payments for the drug group in 12 of the 28 study states. Between Q1 2017 and Q1 2020, payment shares increased by more than 10 percentage points in 5 states (Connecticut, Kansas, Louisiana, South Carolina, and Virginia) and physician dispensing contributed to the rapid growth.

NSAIDS: Payment shares for this drug group changed little in many states, but per-claim payments varied widely in Q1 2020, from $21-$22 per claim in Delaware and Massachusetts to $126 per claim in Louisiana.

Anticonvulsants: Both payment share and per-claim payment for this group decreased in many states over the study period. The decrease happened mostly between Q2 2019 and Q3 2019, when generic formulations of Lyrica became available.

Opioids: The substantial decline for opioids during the study period continues the declines seen in previous periods. The per-claim payments for opioids decreased by 56 percent in the typical state, and the rate of reduction ranged from 40 percent in Louisiana to 81 percent in California.

The 28 states in the study are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. In each quarter, prescriptions that were dispensed for all medical claims with injuries occurring within three years of the prescription fill date and paid under workers’ compensation were included.