Top 5 Specialty Medications in Workers' Compensation
Specialty medications have become increasingly prominent, with 23 novel drug therapies approved by the FDA in early 2024, and specialty medications comprising 75% of drugs in development (1). These medications are essential for treating chronic and complex conditions like cancer, HIV, rheumatoid arthritis, and more. Although there is no formal definition, specialty medications are generally high-cost, require specific handling or administration, and are used for long-term or specialized treatments (2).
Within workers' compensation, specialty medications represent about 1% of all prescriptions but account for 10% of total prescription costs (3). They are widely used by workers in various industries, including healthcare, mining, and first responders, where they provide essential support for chronic and occupational health issues (4). Here are the top 5 specialty medications in workers' compensation, ranked by per-patient per-year (PPPY) spending in 2020 (5):
Truvada® (emtricitabine/tenofovir disoproxil fumarate)
Class: HIV
Indications: HIV infection, pre-exposure and post-exposure prophylaxis
Average Cost: $1,887 per 30-day supply
Notable Usage: Used by healthcare workers and first responders for HIV prophylaxis following needlesticks, with dosing for PEP (occupational post-exposure prophylaxis) of one tablet daily for 4 weeks in combination with a second antiretroviral (6).
Isentress® (raltegravir)
Class: HIV
Indications: HIV infection, pre-exposure, and post-exposure prophylaxis
Cost: $1,664 per 30-day supply
Notable Usage: Often paired with other antiretrovirals for PEP, especially for healthcare workers and first responders at risk of HIV exposure, with a standard dose of one 400 mg tablet twice daily (7).
Synvisc-One® (hylan G-F 20)
Class: Osteoarthritis
Indications: Knee osteoarthritis
Cost: Approximately $1,000 per injection
Notable Usage: Provides up to 6 months of relief from knee osteoarthritis pain common in high-activity jobs; administered by healthcare professionals as a single intra-arterial injection (8, 9).
Enbrel® SureClick® (etanercept)
Class: Inflammatory Conditions
Indications: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
Cost: $1,906 per weekly injection
Notable Usage: Used for RA, a condition often worsened by physical labor. RA treatment typically involves a 50 mg weekly injection, with additional Tuberculosis (TB) testing before therapy (12).
Botox® (onabotulinumtoxinA)
Class: Neuromuscular Conditions
Indications: Chronic migraines, spasticity, cervical dystonia
Cost: $1,300 for a 200-unit vial
Notable Usage: In workers’ compensation, Botox® treats conditions such as chronic migraines and spasticity after spinal cord injuries. Dosage varies; migraine prophylaxis typically involves 155 units every 12 weeks (14).
Growing Impact of Specialty Medications in Workers' Compensation
Specialty medications play a critical role in managing chronic conditions within workers' compensation. As more targeted therapies are developed, their utilization is expected to increase, improving quality of life for patients while preventing the long-term costs associated with untreated conditions. Specialty medications offer significant benefits, from HIV prophylaxis after exposure to managing arthritis and chronic pain, enabling workers to maintain productivity and avoid debilitating health setbacks.
By Lauren Towely
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
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