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Workers compensation drug expenditures have been shifting to antidepressants, anticonvulsants, muscle relaxants and specialty drugs, some of which pose safety and cost concerns.
The prescribing of antidepressants for nerve pain and anticonvulsants such as Lyrica and Gabapentin has been increasing, said Ryan Hamm, Dublin, Ohio-based clinical pharmacist for CorVel Corp.
CorVel is also seeing more prescriptions for muscle relaxants. This is a concern because when combined with other drugs, particularly opioids or benzodiazepines, they can have significant side effects such as depression, drowsiness and dizziness, Mr. Hamm said.
Similarly, myMatrixx, an Express Scripts company, has seen increases in prescriptions for muscle relaxants, antidepressants for off-label use, and anticonvulsants, said Phil Walls, Tampa, Florida-based chief clinical officer.
The pharmacy benefit manager is also seeing a disproportionate share of workers comp drug expenditures going toward specialty drugs.
“There are a lot of newer drugs hitting the market, especially to treat Hepatitis C and HIV that should be on everyone’s radar,” Mr. Walls said. “They make up less than 1% of the prescriptions that myMatrixx processes but drive almost 10% of all of our drug cost, and 50% of the drugs the FDA is currently reviewing fall into this category of specialty drugs.”
The use of opioids for pain management in workers compensation continues to decline, replaced by non-steroidal anti-inflammatory drugs, muscle relaxants and dermatological agents. And while the industry lauds the decline in opioid prescribing, the uptick in usage of the more-expensive alternatives is causing concern.