Retail vs Mail Order Drug Prescribing: Trends and Costs in the Workers' Compensation System - A Preliminary Study Using Pharmacy Benefit Management Data for Ankle Sprain Claims.

OBJECTIVE: This study examines trends and cost disparities between retail and mail order pharmaceutical dispensing within the workers' compensation system. METHOD: Pharmacy benefit management (PBM) data were obtained for ankle sprain claims filed with a nationwide workers' compensation carrier between 2012-2024. RESULTS: During the study period, the ratio of mail order versus retail pharmacies scripts increased. Mail order prescriptions demonstrated higher cost ratios per unit (pill) than retail pharmacies for opioids (1.75), and a sleep agent (1.46), similar costs for analgesics (1.08), antiseizure (0.95), and nonsteroidal medications (0.94) but lower costs for muscle relaxants (0.84). Mail order pharmacies dispensed a longer duration supply per script. CONCLUSION: Mail-order prescriptions consistently provided longer days' supply across all major drug classes, yet they sometime carried higher costs per unit-especially for opioids and sleep agents.