Pharmacy Utilization Patterns and Polypharmacy as Predictors of High-Cost Workers' Compensation Claims: An Updated Cohort Study of Occupational Ankle Sprains.

OBJECTIVE: Evaluate pharmacy utilization patterns as independent predictors of high-cost workers' compensation claims (≥$50,000) for occupational ankle sprains. METHODS: Pharmacy Benefit Management data were integrated into a 9-year cohort of 18,991 claims. Logistic regression modeled individual drug-class utilization and multi-class combinations, adjusting for demographics, industry, litigations, physical complications, treatments, and comorbidities. RESULTS: High-cost risk increased significantly with individual utilization of opioids (OR: 2.19; 95% CI: 1.78-2.69) and antiseizure medications (OR: 4.21; 95% CI: 3.28-5.39). While exclusive nonsteroidals use demonstrated no elevated risk (OR: 0.96; 95% CI: 0.76-1.20), polypharmacy involving three or more flagged drug classes was associated with a 7.71-fold increase in cost escalation (CI: 6.08-9.77). CONCLUSIONS: Early multi-class prescription drug tracking provides a dynamic and real-time indicator of case complexity, allowing interventions from relevant parties to prevent severe financial escalation.