Topical Analgesic Use in Workers’ Compensation

By Vennela Thumula, Te-Chun Liu

August 26, 2021 Related Topics: Prescription Drugs and Opioids, Prescription Benchmarks

Topical analgesics are an important option for treating certain musculoskeletal and neuropathic pain conditions experienced by workers with injuries, as other commonly prescribed pain medications are strictly regulated. However, topical pain medications are a growing prescription cost driver in workers’ compensation. Recently published WCRI drug trends reports indicate that the payment share for topicals in the typical state increased from 9 percent in the first quarter of 2015 to 19 percent in the first quarter of 2020.

This report describes use of topical analgesics for work-related injuries across 28 state workers’ compensation jurisdictions. It can help answer many important questions that state officials, medical providers, and payors may have about topical analgesics, including how often and what types are being dispensed, and if their prescribing is in line with guideline recommendations. The study may be useful in identifying where expensive topical medications, some of which have safety concerns, are being prescribed.

The findings from this study are based on roughly 480,000 workers with prescriptions that had injuries between January 1, 2018, and March 31, 2019, from 28 states. Prescription utilization and medical diagnoses for these workers were tracked for a 12-month period following the injury through March 31, 2020. The 28 study states 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.

Topical Analgesic Use in Workers’ Compensation. Vennela Thumula and Te-Chun Liu. August 2021. WC-21-41.

Copyright: WCRI

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Research Questions:

  • How prevalent was topical analgesic use among workers with prescriptions across the study states?
  • How did payments for topical analgesics vary across states?
  • How often were high-priced private-label topicals dispensed to injured workers, and were they more likely to be dispensed from a pharmacy or a physician’s office?
  • Is dispensing of topical analgesics containing diclofenac and lidocaine consistent with recommendations by treatment guidelines?

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