At $192, the average cost of a workers comp script in Illinois, is the highest among the 17 states WCRI studies, according to the respected research organizations CompScope report. In 2017, the average payment per prescription increased nearly 20 percent, driven by dermatological agents, the report said. The Center Square reporter Cole Lauterbach interviewed CompPharmas Joe Paduda for context. CompPharmas national survey of workers compensation payers showed a 10 percent decrease in cost, Paduda noted, adding What youre seeing in Illinois is essentially a thirty-point swing from the average state thats clearly driven by the overuse of topicals.
CompPharma, LLC has published its 16th Annual Survey of Prescription Drug Management Survey results, and you can download it from the Resources page of this website.
The top finding this year is payers’ focus on transparency in PBM pricing, coupled with ongoing concern. about drug-related issues
Here are the highlights:
Transparency and more visibility into PBM pricing and rebates are top of mind for many respondents. After several years of declining spend and decreases in opioid prescriptions, payers remain vigilant about their pharmacy management programs. They recognize cost drivers can pop up suddenly as they remember physician dispensing and compound schemes. Payers are also considering auditing their PBM to ensure compliance with contract terms.
We appreciate the workers’ comp payers who graciously gave their time and data to participate in the survey. If you’d like to participate in the 2020 survey, email firstname.lastname@example.org. Respondents receive a more detailed version of the report.
Joe Paduda will take self-insured employers on “A Trip Behind the PBM Curtain” at CSIA’s 2019 Employer Summit, October 7. Spread pricing, cost drivers, transparency, rebates, and PBM audits will be discussed. The session starts at 1:45 pm. See the link above for further information.
Joe Paduda provided insight into the Injured Worker Pharmacy (IWP) business model for Boston Globe Reporter Felice Freyer’s article: Andover Pharmacy under investigation for opioid dispensing.
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)
In February, WorkersCompensation.com reported that the Ohio Attorney General Dave Yost had demanded OptumRX refund over $16 million it said the pharmacy benefit manager had overcharged the state’s Bureau of Workers’ Compensation. Read more.
Two Illinois-based risk pools that provide coverage for municipalities filed a complaint yesterday. Most opioid-overuse lawsuits are filed by government entities rather than private entities, said Joe Paduda. Read More.
CompPharma’s 15th Annual Survey of Prescription Drug Management in Workers’ Compensation showed that pharmacy costs in workers’ compensation have decreased by $1.1 billion during the past eight years. “Pharmacy is no longer fastest-growing segment of work comp medical expenses,” said Joe Paduda, president of CompPharma, LLC. “Work comp payers, regulators and PBMs have been extremely successful in reducing drug spend, much more successful than other payers. Survey respondents reported a 9.84 percent decline in total pharmacy costs during the past year, while the national spend across all payer types decreased by a paltry 2.1 percent.” Read More