Injectable Therapies: A Growing Cost Driver in Workers’ Compensation

Nearly four in 10 workers’ compensation claims with significant lost time received injectable therapies within two years of injury, yet payments varied dramatically by state—from as low as $362 in California to as much as $2,404 in Louisiana—according to a Workers Compensation Research Institute study.

Injectable therapies are offered as valuable alternatives to invasive surgeries and addictive oral pain medications, but there is little data on their use and costs in workers’ compensation, the WCRI noted. The study, based on data from 28 states, found that 39% of claims with more than seven days of lost time received at least one injectable therapy at an average cost of $872 per claim.

Emerging Biologics Reshape the Injectable Landscape

The composition of injectable treatments administered to injured workers is undergoing significant transformation. While traditionally established treatments like epidural steroid injections and nerve blocks continue to dominate, newer biologic and regenerative therapies are emerging as increasingly expensive alternatives, according to the study.

Clinically administered injections—including epidural steroid injections, nerve blocks, hyaluronic acid, and botulinum toxin—account for roughly 85% of injectable spending in workers’ compensation, the study found. However, the growth trajectory tells a different story.

Self-administered injectable medications expanded from 7% of payments in 2018 to 15% by early 2024. Within this category, migraine prevention drugs skyrocketed from negligible use to consuming more than half of self-administered injectable spending between 2020 and 2023. Platelet-rich plasma (PRP) injections, meanwhile, increased from 1% of injectable procedure payments in 2018 to 4% by early 2024. Additionally, glucagon-like peptide-1 (GLP-1) antidiabetic agents and other biologics began appearing in a small but growing number of claims, signaling potential future cost implications for workers’ compensation systems.

Concerns About Appropriate Use and Treatment Protocols

The rapid expansion of high-cost injectable options has raised critical questions about whether these treatments are being deployed appropriately, the WCRI said. A central concern involves stepwise treatment protocols—the standard medical practice of beginning with the least invasive, most cost-effective options before progressing to more expensive alternatives.

For many established injectables like pain management procedures, evidence-based guidelines typically recommend they follow oral medications, physical therapy, and adequate healing time. Yet the research did not examine the extent to which providers follow this progression or payors enforce it. Hyaluronic acid treatments present a particularly stark example: these products cost approximately 18 times more than cortisone injections, yet their payment share has increased, raising questions about whether adequate utilization controls exist, the report said.

Newer migraine therapies introduce additional complexity. Recently introduced migraine biologics now represent the top drug class among self-administered injectables by prescription and payment share, yet it remains unclear whether they function as first-line treatments or as alternatives only after older, less costly migraine medications fail, according to the report. The emergence of GLP-1 therapies—traditionally used for diabetes management and weight loss—in workers’ compensation cases further complicates the picture, as guidance on appropriate duration, treatment goals, and stopping rules remains limited.

Coding inconsistencies also obscure the true utilization picture, the report said. Diverse billing practices for injectable drugs and procedures make it difficult to track actual use, potentially hiding the full volume of treatments being administered and raising concerns about billing transparency.

The Critical Need for Evidence and Clear Policies

The rapid adoption of expensive biologic and regenerative treatments has outpaced the availability of independent evidence demonstrating their cost-effectiveness within workers’ compensation populations, according to the report.

Available research on long-term outcomes typically comes from manufacturer-funded or early clinical studies rather than real-world workers’ compensation data. This evidence gap leaves regulators and payers without clear guidance on whether emerging treatments deliver meaningful improvements in worker function and return-to-work outcomes, the WCRI said.

Obtain the full report here. &