NEWS
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 … Continue reading Joe Paduda Presents CSIA Webinar on Facility Costs, Drivers and Solutions
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 … Continue reading The survival of niche PBMs
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 … Continue reading COVID-19 Affects Workers’ Comp, But Not the Way You Think
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 … Continue reading Paduda Weighs in on IWP $11 million Settlement
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 … Continue reading Paduda Will Keynote Day 2 of CSIA’s 2020 Employer Seminar
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 … Continue reading Illinois WC Script Costs Skyrocket
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 … Continue reading CompPharma’s 2019 Survey
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
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’ 104th 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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Pharmacy costs in workers’ compensation have decreased by $1.1 billion during the past eight years, according to CompPharma’s 15th Annual Survey of Prescription Drug Management in Workers’ Compensation. “Pharmacy is no longer the fastest-growing segment of work comp medical expenses,” said Joe Paduda, president of CompPharma, LLC.
Work comp drug costs have dropped by over a billion dollars over the last eight years. What’s even better news is this has been driven largely by sharply lower opioid utilization.
Pharmacy costs in workers’ compensation have decreased by $1.1 billion during the past eight years as the result of fewer opioid prescriptions, among other reasons, according to a study released Wednesday by CompPharma L.L.C.
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Federal workers’ compensation programs fall far behind the regulations established by states and the private sector for opioid prescriptions, resulting in an increased likelihood for opiate abuse and addiction, according to experts who spoke May 8, 2018, before the House Committee on Education and the Workforce.
The workers’ compensation program for federal employees is trailing other large-scale programs in addressing opioid addiction, witnesses told a House Education and the Workforce subcommittee May 8.
Doctors are allowed to prescribe up to two opioids for up to 60 days under Federal Employees Compensation Act guidelines. Some state guidelines for workers’ compensation programs allow initial opioid prescriptions of no more than seven days, Joe Paduda, president of CompPharma, told the panel.
Doctors have long prescribed a muscle relaxant called cyclobenzaprine to treat injuries like back strains, using five- or 10-milligram pills.
But doctors who also dispense the drugs they prescribe directly to patients have recently embraced a new pill that contains 7.5 milligrams of the muscle relaxant. There is no evidence to suggest that the pill works any better except, perhaps, for doctors and the middlemen supplying them. They can charge $3.45, or about five times as much as a five- or 10-milligram pill.
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Tampa, FL – Drug costs still worry workers’ compensation payers, despite relatively flat pharmacy costs, according to the results of CompPharma’s annual survey report of Prescription Drug Management in Workers’ Compensation. Answering the question “How big of a problem are drug costs?” on a scale of 1-5 with 3 being “Drug costs are equally as important at other medical cost issues,” respondents put drug costs at 4.1.
Tampa, Fla. (April 1, 2014) – CompPharma, a consortium of workers’ compensation pharmacy benefit managers, has published results of its research on compounded medications. “Compounding is Confounding Workers’ Compensation” is available here.
“The benefits of compounds are uncertain, and the patient safety issues are profound,” said CompPharma’s President Joseph Paduda. “Insurance companies and other work comp payers are struggling with the increase in compounded drug prescriptions and their high costs. Member PBMs researched the safety, efficacy, pricing, regulation, and reimbursement of compounds to help the industry better understand the possible benefits and address the risks.”
The analysis found no clinical evidence that topical compounds commonly used in workers’ compensation are more effective than commercially available, manufactured drugs. Additionally, the research identified significant patient safety concerns, including inconsistent regulatory oversight, inaccurate dosing in sterile preparations as well as sterility concerns, duplicate drug ingredients and excessive concentrations of drugs in topical compounds.
“Topical compounds frequently contain duplicative ingredients such as two muscle relaxants and/or two non-steroidal anti-inflammatories (NSAIDS),” said Phil Walls, RPh, the paper’s lead author. “There is no clinical rationale for these duplications and there are risks of adverse effects.”
Bulk production of compounds raises questions about whether pharmacies are compounders or manufacturers. “Compounds should be prescribed and prepared for an individual with unique needs such as the inability to swallow the manufactured product or an allergy to ingredients in the manufactured drug,” Walls said. “But some pharmacies create bulk batches of topical compounds and then recommend that physicians prescribe them. Is this compounding or manufacturing?” Walls noted that the Federal Drug Administration regulates pharmaceutical manufacturing but not compounded drugs.
CompPharma recommends prescriptions for compounds require pre-authorization to ensure they are used only when there is a patient-specific requirement, as described above. The pre-authorization request should require:
- Evidence of effectiveness and safety for topical compounds, such as study with a randomized controlled trial published in a peer-reviewed medical journal.
- A letter of medical necessity demonstrating conventional therapy has been tried and failed.
About CompPharma Established by industry consultants Joseph Paduda and Helen Knight, CompPharma, LLC is a consortium of PBMs active in workers compensation. Member PBMs are Catamaran, Express Scripts, HealthCare Solutions, Healthesystems, myMatrixx, and Progressive Medical & PMSI. More information is available at www.comppharma.com.
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Media Contact: Helen Knight, 813-837-1701; helen@kingknight.com
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