Part Two: Evaluating In-Network and Out-of-Network Trends As part of our ongoing drug trends series, in part two of our analysis we’re taking a closer look at the top therapeutic classes by age of claim. Stay tuned for more posts addressing specific trends highlighted in the series. Today we are going to take a deeper dive into Coventry’s Drug Trends by focusing on the influence of claim age as it relates to overall use of prescription drug classes. The data covered here reflects all mail order and retail transactions paid in 2019. When we look at the younger claims (claims less than 2 years of age) Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, steroids, anti-infectives, and non-opioid analgesics are used much more often for the treatment of injuries during the early stages of a claim. The most utilized class remained NSAIDs (i.e. ibuprofen, naproxen or meloxicam) followed by muscle relaxants and short-acting opioids. Notably, the share of short-acting opioids (think morphine, hydrocodone, or oxycodone products) continued to decrease year-over-year coupled with an increase in other 1st-line treatments and are now #3 compared to last year when they were #2 for this age group. These alternative classes that can be used for pain are typically utilized more commonly in younger claims when compared to those claims 2 years or older. Younger claims also utilize more anti-infective agents or steroids which is not surprising considering the types of fills that may fall into the 2 year or less category. Injuries that result in open wounds or broken skin are often treated with antibiotics to prevent infection and it is not unusual to see a one-time fill for these types of medications along with, depending on the severity of the injury, a shorter claim life with closure once the wound resolves. Along the same lines, steroids such as prednisone or dexamethasone are often used to reduce inflammation in respiratory injuries or in musculoskeletal injuries early on (although they can be used later or even years later if there is an injury aggravation). Now let's contrast some of what we have just reviewed for younger claims with the top therapeutic class trends for claims age 2 years and older. Again, there is a positive trend of increased use of opioid alternatives that can often be used for pain management. This follows evidence-based treatment recommendations and mirrors the Food and Drug Administration (FDA) guidelines for limiting the use of extended-release opioids. The biggest difference in the age of a claim is seen in anti-convulsants. These medications were originally on the market for treating and preventing seizures but have shown good evidence in managing pain that is commonly seen in older claims. Namely, chronic pain or neuropathic pain. Additionally, anti-depressants are much more likely to be used in older claims because work related injuries can often cause disruptions to one’s income, home life, or hobbies that tend to build over time and if an injury causes chronic pain, the risk for depression is further worsened. Overall claims with greater medical severity tend to remain open longer than claims that fall within the 2 year or less bracket. Moreover, in these older claims a number of different medications are commonly trialed over the course of 2+ years to find the best treatment option for these patients while trying to lessen negative outcomes. Looking at each claim age bracket and understanding the different claim populations and the types of drug treatments associated can highlight the importance of early and ongoing-targeted intervention, which can ultimately help us to improve return-to-work and make the most of opportunities for impact.
More stories
Delivering The Most-Favored Nation Prescription Drug Pricing to American Patients
Why are U.S. prescription drug prices so much higher than in other developed nations—and what is the government doing about it? A new executive order from the White House could shake up how brand-name drugs are priced and reimbursed, with potential ripple effects across auto and workers’ comp. But is it really a game-changer, or just another attempt at reducing drug costs? Brian Allen, VP of Government Affairs breaks down the executive order and what it could mean for work comp and auto.
Ask The Pharmacist: The Role of Topical Medications in Workers’ Compensation
Topical analgesics—medications applied directly to the skin—are commonly used to manage pain in workers’ compensation claims involving injuries like sprains, strains or muscle aches. While these medications offer targeted relief and are often seen as safer alternatives to opioids, they also present rising cost concerns.
Turn Complexity into Progress: Four Steps to Mastering Specialty Services
In this quick-read guide, you’ll discover how top-performing teams are simplifying fragmented processes to deliver faster, more cost-effective care.
Automate the Chaos: AI, Dashboards, and the Future of Claims
See how data, connected systems, and analytics can help you close claims faster, cut errors, and prevent costly delays.
Simplicity Growth Conference 2025
Simplicity Car Care will host its annual conference, bringing together members from more than 100 locations across Canada.
How One Carrier Saved $2M by Automating Utilization Review Decisions
At a large insurance carrier, adjusters were manually tracking utilization review (UR) determinations and cross-referencing them with incoming medical bills, often across multiple claims. Their traditional manual approach to UR was time-consuming, prone to human error and made it difficult to catch when providers billed for services that had previously been denied or exceeded the authorized limits. As a result, they paid for non-authorized treatments and lost productivity as their adjusters had to spend valuable time on administrative tasks instead of higher-priority responsibilities.