Enlyte Drug Trend Report: Migraine Med Use Soars in Comp Despite Overall Drop in Scripts

Annual PBM report shows increases in overall migraine meds use by nearly 9%, while opioids drop by almost 8%

SAN DIEGO – April 30, 2025 – Despite opioids continuing its hold as the most-prescribed drug class in workers’ compensation, migraine medications and topicals are gaining ground as alternatives to pain management, according to part 1 of Enlyte’s 2025 Drug Trends Report, issued today.

Each year, Enlyte researchers analyze drug utilization and spending trends in workers’ comp to provide the industry with new insights in pharmacy management. Enlyte’s 2025 series reflects on trends clients experienced in 2024, with part 1 focusing on those most often captured by traditional PBM views (in-network prescriptions from retail and mail order). Part 2, which will be released later this year, will highlight a more comprehensive view of pharmacy trends across in- and out-of-network channels. 

Chief among the findings in part 1 is the continuing fall of opioid usage in workers’ comp, which decreased by 7.8% in 2024. However, opioids remain the top-prescribed drug class in 2024, followed by NSAIDs, anticonvulsants, muscle relaxants, and topicals. These five classes represent the majority of total scripts (54.4%) and costs (53.5%). While most of the top 10 drug classes saw drops in overall prescriptions, migraine medications and topical utilization (scripts per claim) continued to increase by 8.7% and 1.8%, respectively.

“What the report shows is the workers' compensation prescription landscape continues to be shaped by guideline-supported trends in pain management and ongoing cost impacts from specialty drugs and high-dollar analgesics,” said Nikki Wilson, PharmD, MBA, senior director, clinical pharmacy solutions. “All opioid categories experienced decreases in utilization, including sustained-release opioids which dropped over 12% in 2024 as supported by prescribing guidelines. Opioid alternatives commonly prescribed to manage acute and chronic pain also saw decreased scripts per claim, although to a lesser degree than opioids.”

Payers are also spending less on the top therapeutic drug classes ranked by comp spend, according to the Enlyte report, even with five of the top 10 therapeutic classes experiencing increased cost per script. The largest script cost increases were driven in part by increases in brand average wholesale price (AWP), jumping 3.2% for topicals and 2.9% for migraine medications.

The researchers also noted a significant relationship in duration of claims and drug utilization/costs in workers’ comp. Enlyte’s data shows that claims open for more than two years account for 92.1% of the total drug spend, while those open 0-1 years account for less than 8%.

“So, basically, the longer a claim stays open, the more likely drug use and costs will increase,” explained Wilson. “More than 85% of total script volume in our records are connected to claims that have remained open for more than two years and, in those cases, average script volume is nearly 15 per person, opposed to about 3 scripts per person in claims less than a year old.” 

To access part 1 of Enlyte’s Drug Trends Report, click here.

About Enlyte

Enlyte (www.enlyte.com) is a P&C industry leader providing claims technology innovations and connectivity solutions, specialty networks, case management, pharmacy benefit and disability management services. Serving over 2,000 entities, including a majority of Fortune 500 employers, Enlyte leverages its portfolio of solutions to simplify processes and improve outcomes for auto, workers’ compensation and disability claims.