Enlyte: Migraine Medications Continue Rising in Workers’ Comp

The use of migraine medications in workers’ compensation prescriptions, despite the overall cost per claim decreasing, a new report shows.

The first part of Enlyte’s 2025 Drug Trends Report released this week shows and migraine medications and topicals are gaining ground as alternatives to pain management, while opioid utilization continued to decline across all categories, including sustained-release opioids.

While opioids continue to be the most-prescribed drug class in workers’ comp, decreased by 7.8% in 2024. The frequency of opioid prescriptions are followed by SAIDs, anticonvulsants, muscle relaxants and topicals. The five classes represent the majority of total scripts (54.4%) and costs (53.5%), the report shows.

Most of the top 10 drug classes saw drops in overall prescriptions.

Utilization of migraine medications rose 8.7% and topical utilization rose 1.8%, the report shows. The largest prescription cost increases were driven in part by increases in brand average wholesale price (AWP), jumping 3.2% for topicals and 2.9% for migraine medications.

Enlyte analyzed drug utilization and spending trends in workers’ comp to provide the industry with insights in pharmacy management. Enlyte’s 2025 series reflects on trends clients experienced in 2024, with part 1 focusing on those most often captured by traditional PBM views (in-network prescriptions from retail and mail order). Part 2, to be released later this year, is set to highlight a more comprehensive view of pharmacy trends across in- and out-of-network channels.

While utilization per claim was down, there was a decrease in cost per claim. Specialty medication spending also continued to increase as a percentage of overall spend, the report shows.

Payers are also spending less on the top therapeutic drug classes ranked by workers’ comp spend, according to the report.

The researchers also noted a significant relationship in duration of claims and drug utilization/costs in workers’ comp. Enlyte’s data shows that claims open for more than two years accounted for 92.1% of the total drug spend, while those open zero to one years accounted for less than 8%.

Top Medications:

Topicals by cost:
1. Lidocaine
2. Methyl Salicylate
3. Diclofenac Sodium
Migraine medications by cost:
1. Nurtec ODT
2. Ubrelvy
3. Qulipta
Specialty medications by cost:
1. Eliquis
2. OFEV)
3. Xarelto
4. Isentress HD
5. TIVICAY