The NSAID meloxicam has emerged as the largest source of anti-inflammatory drug spending in California workers’ compensation, with its share of spending within its drug group rising from 1.7% in 2020 to 30.8% in 2025, according to the California Workers’ Compensation Institute (CWCI).

The increase in the share of payments is notable because meloxicam’s share of anti-inflammatory prescriptions has grown much more slowly, rising from 10.3% in 2020 to 14.7% in 2025. CWCI found that the disparity was largely due to a fairly small number of high-cost meloxicam capsule prescriptions that sharply increased the drug’s average payment. CWCI’s Prescription Drug Interactive Application shows that the average payment for a meloxicam prescription rose from $9 in 2020 to $13 in 2021, $30 in 2022, $41 in 2023, $63 in 2024 and $92 in 2025. The median payment in 2025, however, was still less than $14, indicating that most prescriptions remained inexpensive. The payment distribution for meloxicam prescriptions highlights the disparity as 56% of the 2025 prescriptions had payments of less than $15 while 4.7% had payments ranging from $500 to $2,287.

A review of the National Drug Codes (NDCs), dosages, and formulations associated with the 2025 prescriptions found that four high-cost, generic 5- and 10-mg meloxicam capsule formulations accounted for 12.6% of the workers’ compensation meloxicam prescriptions but 75.7% of the total payments for the drug. The generic capsules from Lupin Pharmaceuticals or Novitium Pharma were dispensed in quantities of 30 or 60. In contrast, traditional 7.5- and 15-mg meloxicam tablets accounted for about 87% of the meloxicam prescriptions in 2025, but at $23 per prescription, they accounted for only about 22% of total meloxicam spending. Thus, most meloxicam prescriptions remain relatively inexpensive, while a small share of high-cost capsules has an outsized impact on overall spending.

The capsules use a fine-particle formulation originally developed for the discontinued brand drug Vivlodex, designed to allow the drug to dissolve and be absorbed differently than conventional meloxicam tablets. According to FDA-approved labeling, the capsule formulation has not demonstrated equivalent systemic exposure to other oral meloxicam formulations and is not interchangeable with them, even at the same milligram strength. The labeling also recommends using the lowest effective dose for the shortest duration consistent with treatment goals. It does not establish that the capsule formulation reduces cardiovascular risk and carries the standard NSAID warning regarding the increased risk of serious cardiovascular events, including heart attack and stroke.

The cost findings highlight an unresolved issue with California’s MTUS Drug Formulary. Although the DWC Pharmacy & Therapeutics Committee discussed distinguishing 5- and 10-mg meloxicam capsules from conventional tablets and included that distinction in draft formulary versions in 2020 and 2021, it was not carried over into the final published drug lists. The current lists do not distinguish between the formulations because the RxNorm Concept Unique Identifier (RXCUI) fields needed to identify them are incomplete. Committee members have repeatedly urged the DWC to complete those fields, and the issue is expected to be discussed again at the committee’s January meeting.

While the data do not establish the clinical rationale for individual prescriptions, they identify the capsule formulations as an area warranting close attention. More complete drug identification in the MTUS Formulary would also help claims administrators, utilization review organizations, physicians and other stakeholders distinguish between formulations and apply the formulary’s intended treatment and review requirements.

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Meloxicam has become the leading anti-inflammatory cost driver in California workers’ comp and CWCI data show that four high-cost generic capsule formulations represented 12.6% of 2025 meloxicam prescriptions but 75.7% of meloxicam spending.