Annual pharmacy benefit manager report shows increases in overall migraine medicine use by nearly 9 percent, while opioids drop by almost 8 percent.

Part 1 of Enlyte’s 2025 Drug Trends Report, issued last month, reveals opioids continue to be the most-prescribed drug class in workers’ compensation. Still, migraine medications and topicals are gaining ground as alternatives to pain management.

The first part of the report by the technology, clinical, and network workers’ compensation industry provider focuses on prescriptions most often captured by traditional PBM views (in-network prescriptions from retail and mail order). Part 2, to be released later this year, will provide a more comprehensive view of pharmacy trends across in- and out-of-network channels.

Despite the continuing fall of opioid usage in workers’ comp, a decrease of 7.8 percent in 2024, opioids remain the top-prescribed drug class in 2024, followed by NSAIDs, anti-convulsants, muscle relaxants, and topicals. The five classes represent the majority of total scripts (54.4 percent) and costs (53.5 percent).

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 percent and 1.8 percent, 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 percent 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 percent for topicals and 2.9 percent for migraine medications.

There is a significant relationship between the 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 percent of the total drug spend, while those open 0-1 years account for less than 8 percent.

“So, basically, the longer a claim stays open, the more likely drug use and costs will increase,” explained Wilson. “More than 85 percent 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.”