Navigating evolving treatments in workers’ comp

Medical treatment in workers’ comp is evolving fast. As innovative therapies and clinical approaches emerge, we’re finding new ways to improve recovery and return-to-work outcomes for injured workers. 

Take GLP-1 agonists, for example. Over the last few years, these medications have exploded in popularity and have contributed to a recent decline in obesity rates. Now, they’re starting to be covered by some employers under workers’ comp as the connection between weight loss and faster injury recovery becomes clearer. 

New treatments like these require extensive evaluation and careful consideration to be covered. Beyond ensuring patient safety, clinical decision-makers must also weigh other treatment factors like long-term effectiveness and employer cost. 

Emerging and controversial treatments in workers’ comp

The rapid pace of medical innovation means that new treatments often enter the market before their effectiveness is fully understood. At the same time, new research is challenging the value of some long-standing or controversial ones. 

In both cases, employers should proceed with caution. Here are some emerging and controversial treatment options, and what employers need to know about them when it comes to workers’ comp:

• LSD: MindMed has launched phase three of trials for a single, 100 mcg oral-disintegrating tablet of LSD for generalized anxiety disorder. Early results are striking: At 12 weeks, 65% of participants showed a positive response, and 48% achieved total remission of anxiety. If approved, LSD could become the first psychedelic drug for this indication. Though it was recently granted breakthrough status by the FDA, questions remain about long-term safety, integration into workers’ comp programs and how this novel therapy would be managed in clinical practice.

• Platelet-rich plasma (PRP): This treatment involves extracting blood, spinning it down to isolate plasma and platelets, then injecting it into tendons and ligaments. PRP is commonly used to treat injuries in professional sports and can be effective for certain soft tissue injuries. While PRP is permitted off-label, it’s not FDA-approved and can cost up to $1,000 per injection. Additionally, some providers use PRP injections more broadly than evidence supports, using them for conditions where they may not be effective. 

• Stem cell therapy: This procedure involves extracting cells from long bones or the pelvis and injecting them into a specific body part — like a back, knee or shoulder — to help repair damaged tissue. Stem cell therapy is often marketed to self-pay patients like athletes or those seeking performance improvement, and can cost upwards of $10,000. Despite its popularity, there’s no clinical evidence supporting its effectiveness for musculoskeletal injuries, making it inappropriate for coverage under workers’ comp.

• Peptides (BPC-157 and TB500): These types of peptides are controversial yet widely available online. Their effects have been studied extensively in animals — especially in racehorses — and are banned by the Olympic Committee due to concerns about performance enhancement. While patients may request them for soft tissue injuries, orthopedic surgeons generally decline due to a lack of human clinical trials. The groundswell of anecdotal support is not matched by scientific evidence.

• Hyaluronic acid injections: Since the late 1970s, hyaluronic acid injections have been used to create a buffer between bones in severe osteoarthritis cases. While recent research shows that these injections aren’t effective, many providers still use them. 

• Suzetrigine: Approved in January 2025, this new non-opioid pain medication is intended for short-term postoperative use (10 days). However, some chronic pain specialists are prescribing it for much longer periods — 30, 60 or even 90 days — despite pharmacists and injured workers reporting that its effectiveness diminishes over time. Suzetrigine is also very expensive, so close monitoring is essential.

• Motrin 300 mg: This medication has long been available in 200 mg tablets, but a new 300 mg dosage is now on the market at a much higher price — up to $1,000 for a month’s supply. There’s little clinical justification for the price difference, and many states treat it as a brand-name drug, recommending lower-cost alternatives.

Evaluating medical necessity and evidence

With so many new treatment options, ensuring the right care for injured workers requires a rigorous approach to medical necessity, clinical review and evidence-based protocols. As the world’s leader in integrated managed care, Sedgwick’s utilization review services can help with that. Here’s how:

• Treatment plan review: Our nurses review and negotiate treatment plans to ensure that care is appropriate, medically necessary and helps employees get back to work. For example, this could include declining ineffective hyaluronic acid injections or negotiating PRP pricing. 
• Evidence-based approach: We ensure every medical intervention is supported by strong clinical evidence. Treatments lacking research — like stem cell therapy or certain peptides — are approached with caution, especially when costs are high and benefits are uncertain.
• Proactive monitoring: Our team of pharmacists and clinicians continually monitors emerging therapies. By staying ahead of trends and applying statutory guidelines, we help employers avoid unnecessary or unproven treatments.

Optimizing outcomes in an evolving environment

No matter the type of injury, the goal is to deliver the best possible recovery outcome while controlling costs and ensuring safety. By rooting every decision in evidence, clinical review and medical necessity, employers can navigate the evolving treatment landscape with confidence.

At Sedgwick, we’re committed to staying ahead of emerging trends, advocating for our clients and ensuring every treatment decision is grounded in science and best practice. Click here to learn more about our managed care services and how we deliver industry-leading return-to-work experiences and outcomes.