CompPharma analyzes clinical and transactional pharmacy data, identifies potential problems and works with payers to improve pharmacy programs. If you want help sorting through the complexity of work comp pharmacy, need expert assistance when evaluating RFPs, or want to see if your PBM really complies with your contract, it’s worth a fact-finding conversation to see if we can help.
Call Joe Paduda at 203-314-2632 or email email@example.com
We provide pharmacy management consulting services to:
How do healthcare providers price services to group health plans, workers’ compensation, Medicare, Medicaid? Joe will compare what different payers pay for facility, provider and pharmacy services when he speaks at NCSI’s annual meeting in Orlando on June 10.
Attorneys general in 44 states have filed a lawsuit against 20 of the nation’s largest generic drug manufacturers accusing the companies of conspiring to artificially inflate the prices of 114 different generic drugs, including many commonly prescribed in workers’ comp. Reporter Elaine Goodman interviewed Joe Paduda for perspective on the inexplicable price increases for generics. Subscription required. Read More
Joe Paduda questioned Optum’s industry trend report’s suggestion that there may be a shift from meds to physical therapy and other ancillary services. He told Elaine Goodman, that just because spending for durable medical equipment or physical therapy went up while drug costs went down doesn’t mean one caused the other. “Moreover, we don’t know if DME spend is higher due to adjusters using Optum DME for more complex patients, or Optum’s prices for DME are higher,” Paduda said. “The report provides no data to support the inference that drugs are being replaced by other services.” See more (subscription required)
Pharma Blogs from Joe Paduda
Do you have any idea if you are paying your PBM what you should? Work comp payers’ PBM pricing is based on AWP; typically it is a percentage below AWP. Brand drugs are discounted 10-16%, and generic pricing is typically … Continue reading Explaining pharmacy pricing, part 4
Here’s the thing about “list” prices for drugs – the more accurate definition of AWP is “Ain’t What’s Paid.” The REAL price is what is paid AFTER rebates and other discounts are applied. That’s why the current media frenzy over … Continue reading Explaining pharmacy pricing, part 3
And to kick it off, here are quick facts about work comp pharmacy… Total workers’ comp drug spend was about $4 billion last year. Others will argue it’s much higher, after 15 years of digging into the data I’m quite … Continue reading It’s work comp pharmacy week at MCM