Top 5 Work Injuries That Require Specialty Medications
Work-related injuries and illnesses affect millions of workers each year. According to the Insurance Information Institute (III), more than 2.2 million work-related injuries and illnesses resulted in time away from work between 2021 and 2022. The top 10 most reported industries accounted for 97.6% of these cases, with the service industry leading at 24%, followed closely by transportation and material moving at 22.4%.
In 2022, the U.S. Bureau of Labor Statistics reported over 600,000 cases of illness related to work, with respiratory conditions accounting for 78% of these annual illnesses. In the same year, nearly 2.9 million work-related injuries were reported, with over 500,000 cases involving strains, sprains, or tears.
As these numbers show, work-related health issues are widespread, and specialty pharmacy plays a crucial role in supporting the recovery and well-being of those affected.
In previous articles, we defined specialty drugs and highlighted the top 5 specialty medications in workers' compensation. Below is an overview of 5 common workers' compensation conditions and the career fields most frequently associated with work-related illnesses that require specialty medications for treatment.
1. HIV and Hepatitis C
Overview
Human Immunodeficiency Virus (HIV) is a retrovirus typically transmitted through direct contact with blood or bodily fluids containing the virus. Co-infection with Hepatitis C Virus (HCV) is common, occurring in about 20% of individuals diagnosed with HIV. In workers' compensation, coverage is usually prophylactic following exposure to blood or bodily fluids of unknown or confirmed HIV and/or HCV status.
Risk in Healthcare
Healthcare workers, particularly those in fields like nursing (NAICS 62), face a higher risk of HIV and HCV exposure through accidental needle sticks or Sharps injuries. According to the CDC, the annual incidence of these injuries is estimated at 385,000. Post-exposure prophylaxis (PEP) for HIV should begin immediately, even before HIV test results are confirmed, and can be discontinued if the test result is negative.
Treatment Options
HIV PEP Medications: Truvada® (emtricitabine), Tivicay® (dolutegravir), Isentress® (raltegravir), and Viread® (tenofovir DF).
Hepatitis C Treatment: The CDC does not recommend PEP for Hepatitis C. However, if diagnosed, antiviral treatments such as Harvoni® (ledipasvir/sofosbuvir) may be used.
Additional HIV Options: Triumeq® (abacavir/dolutegravir/lamivudine), Complera® (emtricitabine/rilpivirine/tenofovir), and Kaletra® (lopinavir/ritonavir).
2. Pulmonary Fibrosis
Overview
Pulmonary fibrosis occurs when lung tissue becomes damaged and scarred, making it difficult for the lungs to work properly. This scarring can lead to breathing difficulties and reduced oxygen levels in the bloodstream. While some cases are idiopathic (with no known cause), pulmonary fibrosis can also be drug-induced or caused by occupational exposure to harmful dusts and chemicals.
Occupational Risk
Occupations with the highest risk of pneumoconiosis, a type of pulmonary fibrosis caused by inhaling harmful particles, include:
Coal Mining (NAICS 21)
Construction (NAICS 23)
Manufacturing (NAICS 31-33)
Common subtypes include asbestosis, silicosis, and coal workers' pneumoconiosis.
Treatment
While there is no cure for pulmonary fibrosis, certain medications can help slow disease progression, such as Ofev® (nintedanib).
3. Osteoarthritis
Overview
Osteoarthritis is the degeneration of joint cartilage, causing pain, stiffness, and difficulty with movement. The condition commonly affects joints such as the knees, hips, hands, shoulders, and ankles. It often develops due to repetitive motions like squatting, lifting, or climbing stairs.
Occupational Risk
Certain occupations, particularly those requiring repetitive movement or heavy lifting, have a higher risk of developing knee osteoarthritis. These include:
Construction (NAICS 23)
Firefighting (NAICS 922160)
Mining (NAICS 21)
Agriculture, Fishing, and Forestry (NAICS 11)
Treatment Options
Common specialty medications for osteoarthritis include hyaluronic acid injections like:
Synvisc-One®
Euflexxa®
Orthovisc®
Gel-One®
Monovisc®
Supartz FX®
An alternative option is injectable Prolia® (denosumab), which is not a hyaluronate.
4. Rheumatoid Arthritis
Overview
Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes systemic inflammation, often affecting the joints. It is commonly genetic but can be exacerbated by environmental factors. Though not directly work-related, certain work environments may aggravate existing RA symptoms.
Occupational Risk
While RA isn’t directly linked to specific occupations, research has shown that certain jobs can increase the risk of developing or worsening RA. These include:
Bricklayers (NAICS 238140)
Concrete Workers (NAICS 238110)
Material Handlers (NAICS 33392)
Electrical Workers (NAICS 23821)
Nursing Assistants (NAICS 623)
Treatment Options
Specialty medications for RA include:
Humira® (adalimumab)
Enbrel® (etanercept)
Otezla® (apremilast)
Orencia® (abatacept)
5. Occupational Cancers
Overview
Cancer involves the uncontrolled growth of abnormal cells and can originate in various organs or tissues before potentially spreading to other parts of the body. Occupational cancers, which account for an estimated 2-8% of all cancer cases worldwide, are caused by exposure to carcinogenic materials or toxic substances.
Occupational Risk
Occupations with a higher risk of developing cancer include those with frequent exposure to hazardous substances, such as:
Firefighting (NAICS 922160)
Rubber Manufacturing (NAICS 3262)
Paving (NAICS 32412)
Roofing (NAICS 238160)
Painting (NAICS 238320)
Chimney Sweeping (NAICS 561790)
Common Occupational Cancers
Lung cancer
Mesothelioma
Bladder cancer
Leukemia
Treatment Options
While chemotherapy remains a primary treatment, specialty medications for cancer include:
Bosulif® (bosutinib) for leukemia
Zydelig® (idelalisib) for leukemia
Ninlaro® (ixazomib) for multiple myeloma
With oncology medications continuously evolving, 25 new agents were FDA-approved between January and October 2023, with over 2,000 more in development.
The Role of Specialty Medications in Workers’ Compensation
Specialty medications, while more expensive than traditional treatments, provide several key benefits in the workers’ compensation space. These medications can help slow disease progression or even cure certain conditions, rather than merely addressing symptoms. In some cases, such as osteoarthritis injections, treatments are administered only once every six months, leading to less frequent intervention but significant long-term benefits for patients.
By Lauren Towely
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
References:
https://www.iii.org/fact-statistic/facts-statistics-workplace-safety-workers-comp
https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm
https://www-dynamed-com.ezp2.lib.umn.edu/condition/overview-of-hiv-infection#GUID-E57D543C-1359-4FF8-9608-83B2937E9704
https://www.cdc.gov/infection-control/hcp/sharps-safety/program-workbook.html#:~:text=The%20Centers%20for%20Disease%20Control,by%20hospital%2Dbased%20healthcare%20personnel.
https://www.cdc.gov/hepatitis-c/hcp/infection-control/index.html
https://healthesystems.com/rxi-articles/6-specialty-drug-trends-impacting-workers-comp-right-now/
https://www.lung.org/lung-health-diseases/lung-disease-lookup/pulmonary-fibrosis/introduction#:~:text=What%20Is%20Pulmonary%20Fibrosis%3F,absorb%20oxygen%20into%20the%20bloodstream.
https://www.pulmonaryfibrosis.org/understanding-pff/types-of-pulmonary-fibrosis/occupationalpf
https://www-dynamed-com.ezp2.lib.umn.edu/results?q=osteoarthritis&lang=en
https://pmc.ncbi.nlm.nih.gov/articles/PMC4562436/#R21
https://www-dynamed-com.ezp2.lib.umn.edu/condition/rheumatoid-arthritis-ra#TOPIC_FQZ_BQQ_HHB
https://www.ajmc.com/view/certain-occupations-associated-with-an-increased-risk-of-rheumatoid-arthritis
https://www.cdc.gov/niosh/cancer/about/index.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC1865426/
https://www.uspharmacist.com/article/trends-in-fdaapproved-cancer-therapies#:~:text=Over%20the%20past%2030%20years,oncology%20therapeutics%20since%20January%202023.
https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-oncology-trends-2023#:~:text=The%20number%20of%20products%20under,down%20from%2036%25%20in%202017.