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

Joe Paduda, president of CompPharma, LLC, will testify before the U.S. House Committee on Education and the Workforce Subcommittee on Workforce Protections hearing about opioids. “The Opioid Epidemic: Implications for the Federal Employees’ Compensation Act” hearing starts at 10 a.m. on Tuesday, May 8.
“Unfortunately, when it comes to dealing with the opioid crisis, FECA is five or six years behind the rest of the workers’ compensation industry,” Paduda said. Read More

That’s the key lesson from a session on dealing with legacy opioid claims at the International Association of Industrial Accident Boards and Commissions’ 104^th convention in Virginia.

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The California Division of Workers’ Compensation’s recent changes to the nine-month-old drug formulary specifically list several newly named drugs as prohibited for pain management — baffling experts who say some of these drugs are unusual for treating pain and wonder why they are being introduced into the new formulary language.

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