Oakland, CA — 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 over the last six years the average payment for a meloxicam prescription went 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 just $23 per prescription, they accounted for only about 22% of total meloxicam spending.

The capsules use a fine-particle formulation originally developed for the discontinued brand drug Vivlodex, that allows the drug to dissolve and be absorbed more quickly than conventional meloxicam tablets. According to FDA-approved labeling for the capsule formulation, it 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, however, establish that the capsule formulation reduces cardiovascular risk and it carries the standard NSAID warning regarding the increased risk of serious cardiovascular events, including heart attack and stroke. Because the 5- and 10-mg meloxicam capsules are classified as non-exempt drugs by the California workers’ compensation formulary they are subject to prospective utilization review, unlike conventional meloxicam tablets.

CWCI notes that while most meloxicam used in California workers’ compensation remains relatively low cost, the small percentage of high-cost capsule prescriptions are having a growing impact on the overall cost of the drug, underscoring the importance of examining prescription-level and NDC-level data when evaluating changes in workers’ compensation drug costs. The data do not address the clinical rationale for individual prescriptions, and the capsules may be appropriate for some injured workers, but the meloxicam capsule formulations are subject to prospective utilization review so they warrant close attention when authorization is requested, which may include review of the clinical rationale and supporting documentation and discussions with the prescribing physician.