Among COVID-19 and delayed surgeries, reductions in Medicare/Medicaid reimbursement, rising unemployment and other economic pressures, hospitals are having a tough time financially. And, facilities are looking to workers’ comp to help make up the revenue. Employers in most states are paying 3 to 8 times Medicare’s cost for facility fees.
Joe Paduda will discuss the effect of these external cost drivers on workers’ compensation and ways self-insured employers can mitigate them in a one-hour webinar for the California Self-Insurers Association. The webinar starts at 10:30 a.m. Pacific/1:30 Eastern on November 17.
The webinar is free to CSIA members and available for $25 to non-members. Register here.
Managed Healthcare Executive’s Susan Sadika quotes Joseph Paduda in this article on how niche PBMs survive in a world of mega PBMs better buying power. “They have to compete on the basis of something else, such as focusing on certain diseases or niche businesses, such as workers’ compensation,” Paduda says.
The piece points out that size gives larger PBMs better buying power and Paduda acknowledges that makes it tough to compete. Large PBMs can negotiate rebates (which are controversial) and discounts from drug manufactures. While not exclusive to workers’ comp, the article gives WC payers insight into the pharma world and is worth the read.
COVID-19 has hit workers’ comp hard, but it’s not the disease or its costs. It’s the economic devastation that will have deep and broad effects, writes Joe Paduda in WorkCompWire’s Leaders Speak. He argues that the industry’s focus on profitability is misplaced and explains why in this article.
The Mass.-based mail-order pharmacy Injured Workers Pharmacy settled charges that it dispensed excessive amounts of opioids without monitoring for safety. When reporting on the $11 mil. settlement, WorkCompCentral’s William Rabb asked Joe Paduda to comment. “A dozen years into the opioid crisis, it is stunning that any pharmacy would engage in the activities described in the AG’s complaint,” Paduda said. He advised payers to review all payments to IWP and assess amounts of opioids supplied to patients to make sure they are not in danger.
The state’s Attorney General Maura Healey’s complaint alleged that IWP “paid referral fees to doctors, claimants’ attorneys and others in exchange for the names of injured workers who were candidates for pain medication,” Rabb wrote. Its sales incentive plan required pharmacists to fill and ship new scripts the day they came in – even before verifying the patient’s address and workers’ comp claim. Read the whole article (subscription required).
Day 2 of the California Self-Insurance Association (CSIA) Employer Seminar & Annual Meeting & Educational Conference will start with an informative session “Managing your PBM to Achieve Great Results.” CompPharma’s Joe Paduda will share insights from his annual survey on workers’ compensation pharmacy management programs along with lessons learned from audits of WC PBMs. Audits typically show that 5 to 7% of drug costs billed to employers are inappropriate. See the breakdown. Plan to attend the CSIA conference – April 20-21 at the Disneyland Hotel in Anaheim, CA. Learn more at https://www.caself-insurers.com/events
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 email@example.com. Respondents receive a more detailed version of the report.
Read more here: CompPharma Survey Reveals Payer Concern Over PBM Transparency in Pricing
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.