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WCRI Session That I Attended – Shocking Topicals Numbers


WCRI Session – Off-Label Prescribing and the Effects of Opioid-Related Policies

WCRI Session Speakers: Vennela Thumula, PhD, Bogdan Savych, PhD

The data from this WCRI (Workers Comp Research Institute) session yesterday provided indications of shocking increases in topicals.  The session also pointed out that the effects of state opioid-related policies were negligible.   

wcri session graph of diclofenac prescriptions
Wikimedia Commons – ClinCalc DrugStats

Topicals are anything that is applied to the skin such as patches, creams, and gels.   If one looks at the chart above for diclofenac, the use is also spiking for the overall market. 

South Carolina led the way with 40% of prescriptions having a dermatological component. 

Some of the numbers from this session were:

Opioid prescriptions 

  • 21% of prescriptions – 2015 – were opioids
  • 202o – the percentage of opioid prescriptions were reduced to 8% of prescriptions 


  • 11% of prescriptions in 2015
  • 21% – that seems to be a rather large number for topicals 

I was not expecting the percentage to be that high.  

The two top topicals that were responsible for the topical prescriptions were Diclofenac and Lidocaine.    Approximately 91% of the topical prescriptions written were Diclofenac and Lidocaine. 

What is Diclofenac topical?

-next two sections not part of the presentation 

 According to Drugs.com, Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

Diclofenac topical (for the skin) is used to treat joint pain caused by osteoarthritis. diclofenac topical is for use on the hands, wrists, elbows, knees, ankles, or feet. Diclofenac topical may not be effective in treating arthritis pain elsewhere in the body.

What is lidocaine topical?

Lidocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body.

Lidocaine topical (for use on the skin) is used to reduce pain or discomfort caused by skin irritations such as sunburn, insect bites, poison ivy, poison oak, poison sumac, and minor cuts, scratches, or burns. Lidocaine topical is also used to treat rectal discomfort caused by hemorrhoids.

Lidocaine topical may also be used for purposes not listed in this medication guide.

DE and SC have the highest use of topicals.  I would have to agree with this statement when analyzing claim payments.

The physicians in FL, GA, IL, MD, DE, SC, and VA supplied 20 – 30% of the topical medications in 2020.  

WCRI Session Best Question

What have states done to control the spike in topical prescription medications?    A few of the states have included topical prescriptions in their drug formularies. OH, NY and KY have included them recently.  

This WCRI session provided a great insight into what is now becoming a problem with Workers Comp treatment.   This was a great session with excellent presenters. 


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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

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