Ask The Pharmacist: 5 Medication-Related Fraud Signs Work Comp Adjusters Should Know
7 MIN READ
Pharmacy fraud represents one of the fastest-growing cost drivers in workers’ compensation claims. While most health care providers operate with integrity, fraudulent prescribing patterns can inflate claim costs by thousands of dollars, sometimes without adjusters noticing until significant damage has occurred.
Pharmacy Patterns as Predictors of Workers’ Compensation Claim Complexity
10 MIN READ
Workers' compensation claims vary dramatically in complexity, duration, and cost. While some injured workers recover quickly with minimal intervention, others experience prolonged disability requiring extensive medical treatment. Pharmacy data provides a unique window into claim trajectory, often revealing patterns that predict complexity before other clinical indicators emerge.
Retail and Mail Order Prescriptions
3 MIN READ
Overall cost and utilization by claim were down in 2025 even with 6 of the top 10 therapeutic classes experiencing rising cost per script. Migraine medications rose by nearly 10%, representing the largest script cost gains driven in part by increases in brand Average Wholesale Price (AWP) including brand AWP for migraine medications increasing 2.4%. Utilization per claim also jumped in the migraine medication class (up 9.6%), while every other class within the top 10 (besides topicals, which rose 2.5%) experienced decreased utilization.
Ask The Pharmacist: What Work Comp Adjusters Should Know About New Generic Tapentadol
4 MIN READ
Generic versions of Nucynta are now available in the U.S. market. For workers’ compensation claims, this may create brand-to-generic conversion opportunities, especially as part of a longer-term pain regimen.
A 16,000% Problem: Why Workers’ Comp Can’t Get Drug Costs Under Control
Workers’ comp pharmacy costs continue to rise due to limited network control. Learn how structural gaps drive pricing abuse and what states can do to fix it.
Five Pain Management Trends Workers’ Compensation Leaders Should Watch
2 MIN READ
Workers’ compensation pain management trends are shifting as non-opioid therapies, topicals and high-cost drugs reshape pharmacy program oversight. See five trends that can help claims leaders evaluate cost, utilization and clinical strategy.
Ask The Pharmacist: Medication Step Therapy in Workers’ Compensation
3 MIN READ
When you review a medication request, it’s not always clear why one drug is approved first and another is not. That is where step therapy comes in. In workers’ compensation, step therapy gives you a structured, evidence-based framework for evaluating medication requests, starting with well-supported, lower-risk treatments before moving to other options when medically necessary.
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