Prescription Pain Medications and Workers’ Compensation Costs
Prescription medications, especially pain relievers, are often an important part of recovery after a workplace injury. Over the past decade, insurers and state systems have adjusted policies to balance effective pain management with safe, cost-conscious care.
Medication Costs in Workers’ Compensation
The National Council on Compensation Insurance (NCCI) reports that prescription drugs account for about 7% of total medical costs in workers’ compensation claims (NCCI, 2022). While this percentage has decreased in recent years, medications remain a key driver of claim expenses.
Shifts in Pain Medication Prescribing
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In 2012, more than 50% of workers’ compensation claims with prescriptions included opioids. By 2021, that number had dropped to under 30% (NCCI, 2022).
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The Centers for Disease Control and Prevention (CDC) found a similar trend: opioid prescriptions in workers’ compensation cases declined from 55% of claims in 2012 to 32% in 2022 (CDC, 2023).
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The average amount prescribed per claim has also decreased, reflecting more cautious prescribing practices (NCCI, 2022).
These reductions suggest that workplace injury treatment is shifting toward safer and more cost-effective pain management strategies.
Impact of Guidelines and Formularies
After the 2016 CDC opioid prescribing guidelines, one study found that workers’ compensation case durations dropped significantly — from an average of 635 days to 438 days (PubMed, 2023). This indicates that changes in prescribing practices can improve recovery timelines as well as cost outcomes.
Many states, including New York, now use drug formularies or prescription monitoring programs to guide treatment. According to NCCI, these systems help ensure medications are prescribed appropriately while still allowing flexibility for physicians to manage patient needs.
What It Means for Workers
For injured employees, this trend does not mean that pain management is being ignored. Instead, it reflects an effort to:
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Support recovery with effective treatment
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Reduce risks associated with long-term medication use
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Ensure workers’ compensation systems remain sustainable
Care decisions remain between patients and their healthcare providers, with insurers focusing on providing coverage that balances safety, effectiveness, and cost.
FAQs
Do prescription pain medications always raise workers’ comp costs?
Not always, it can be effective. Extended or high-dose prescribing is what typically increases costs and claim durations.
Why are insurers focused on prescription monitoring?
Monitoring helps prevent unnecessary costs, reduces risks of dependency, and tracks weather workers get safe treatment.
Are alternatives available for injured workers?
Yes. Many treatment plans include physical therapy, non-opioid medications, and interventional procedures, depending on the type of injury.
Request an Appointment
If you’ve been injured at work, we can help connect you with a trusted provider in your area. Request an appointment today, and our team will connect you directly with the provider’s office.
This blog from Pain and Injury is intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Recovery is not guaranteed, and each patient’s results may vary. Always consult a qualified healthcare professional for a personalized care plan.