510-257-4141
By Steve Franco
Recent trends in California’s workers’ compensation system have highlighted a significant shift in the types and costs of medications prescribed for migraines. According to a recent California Workers’ Compensation Institute (CWCI) report, there has been a nearly eightfold increase in the use of migraine medications between 2018 and 2023. While migraine medications still account for a small fraction of overall workers’ compensation prescriptions, their cost impact is growing at an alarming rate, now representing 4.7% of the total workers’ comp drug spend, up from just 0.6% in 2018.
The Evolution of Migraine Drug Prescriptions
The increasing reliance on new, high-cost migraine medications not included in the Medical Treatment Utilization Schedule (MTUS) formulary is a key factor driving these rising costs. These drugs require prospective utilization review, adding complexity to the treatment approval process. The CWCI study shows that several newer, high-cost migraine medications such as Nurtec ODT and Ubrelvy have quickly gained popularity, surpassing older and more affordable options like sumatriptan and rizatriptan. For instance, Nurtec’s share of migraine drug payments surged from 12.8% in 2021 to 41.6% in 2023, with average prescription costs climbing to $1,675.
Implications for Employers and Insurers
This trend is concerning for employers and insurers, as migraine treatments are becoming a significant cost-driver in the workers’ compensation system. The rapid growth of high-cost drugs for migraine relief, including preventative and acute treatments, is approaching the expenditure levels historically reserved for opioids. In fact, migraine drug costs now exceed those of antidepressants and musculoskeletal medications, categories that were once dominant in workers’ compensation drug spending.
For employers, this means potential increases in workers’ compensation premiums as these costs accumulate. In some cases, the long-term nature of migraine treatment may contribute to higher overall costs due to the chronic nature of the condition. Additionally, the expanding list of migraine triggers and the challenges of establishing work-related causation add to the complexity of these claims.
The Role of Legal Representation
As an attorney, I’ve witnessed firsthand how important it is to ensure that injured workers receive appropriate treatment while also keeping the financial aspects of workers’ compensation in check. The rise of high-cost migraine drugs, which may not be necessary or work-related, creates additional hurdles for workers and employers alike. At Franco Muñoz Law Firm, we understand the complexities involved in cases where medication costs play a major role, and we are committed to advocating for fair outcomes.
If you or someone you know has experienced a workplace injury, including conditions that involve high-cost medications like those for migraines, it’s important to consult with a skilled workers’ compensation attorney. We can help navigate the complex landscape of utilization reviews and ensure that you receive the care you deserve while managing costs effectively.
Contact us today at (510) 257-4141 for a consultation. You can also visit our website at www.francomunoz.com to learn more about how we can help you with your workers’ compensation case.
About Steve Franco
Steve Franco is a highly experienced workers’ compensation attorney and co-founder of Franco Muñoz Law Firm. Based in Oakland, California, Steve has successfully handled numerous complex cases, securing six-figure and million-dollar settlements for injured workers. Known for his tenacity in litigation and deep knowledge of California workers’ compensation law, Steve is passionate about ensuring his clients receive the medical care and financial support they deserve. You can learn more about Steve’s background here.
