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Digital EditionOpioid Use Drops While Specialty Drug Costs Surge in Workers’ Compensation
Workers’ compensation prescription costs increased 4.3% per claim in 2024 despite a 5.5% drop in opioid utilization, as high-cost topical medications and migraine treatments drove spending increases, according to Enlyte’s 2025 Drug Trends report.
The pharmaceutical landscape in workers’ compensation continues its transformation away from opioid-based pain management, according to the report, which analyzes prescription cost and utilization trends across in-network and out-of-network channels.
The percentage of injured employees using opioids decreased to 20.1% in 2024, while high-dose opioid prescriptions exceeding 90mg morphine equivalent dose plummeted 10.2%, the report said. Average morphine equivalent dose per prescription fell 3%, marking a decade-long downward trend.
These improvements stem from collaborative clinical programs between pharmacy benefit managers and employers that emphasize evidence-based pain management, according to Enlyte. The shift has resulted in a 7.2% decrease in opioid cost per claim, even as alternative therapies gained ground.
Generic medication utilization reached 88.9% in 2024, up nearly a full percentage point from the previous year. Average wholesale price inflation moderated to 1.5%, down from 4.4% in 2023.
Cost Inflation Concentrates in Specialty Categories
While overall utilization of prescribed drugs declined 0.8%, specific therapeutic areas experienced dramatic cost increases that offset savings from reduced opioid use, according to the report. Topical medications now rank first in overall cost, with spending per claim jumping 15.5% alongside a 5.9% utilization increase.
The most concerning trend involves what the report classifies as “opportunistic products”—primarily private-label topical analgesics marketed directly to physicians’ offices with the aim of increasing profits, the report noted. These products represent just 3.9% of prescription volume but account for 20.5% of total costs. In out-of-network settings, topical medications comprise 13.9% of prescriptions but consume 40.2% of spending.
Migraine medications emerged as another cost driver, with utilization surging 15.2% and cost per claim spiking 20.5%. Three newer calcitonin gene-related peptide inhibitors—Nurtec, Emgality, and Ubrelvy—ranked among the top five migraine prescriptions, reflecting their growing use for post-concussion headaches, occupational exposures, and stress-related migraines, the report said.
Managing the Full Prescription Landscape
The disparities between in-network and out-of-network channels for prescriptions underscore the need for comprehensive pharmacy management strategies, according to Enlyte. Prescriptions filled through traditional pharmacy networks average 6.8 years in claim age with 77.2% involving multiple fills, while out-of-network prescriptions captured through medical bill review average just 2.4 years in age with only 31.2% involving refills.
This difference highlights how acute, short-term treatments often bypass traditional pharmacy controls, creating opportunities for cost inflation. Out-of-network opportunistic products carry a 34% cost premium compared to in-network alternatives, demonstrating the financial impact of fragmented prescription management, the report said.
Organizations focusing solely on in-network penetration and pre-dispensing controls risk leaving significant portions of their prescription spending vulnerable to clinical and financial risks, according to Enlyte.
Obtain the full report here. &
