NEWS

Joe Paduda Will Explain How Healthcare Providers Price Services at NCSI

News Release, May 21, 2019

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.

States’ Lawsuit Accuses Manufacturers of Generic Drug Price-Fixing

WorkCompCentral, May 14, 2019

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

PBM Report Suggests Shift in Spend from Drugs to Other Services

WorkCompCentral, April 30, 2019

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)

OptumRX Overcharging Case: A Catalyst For Change?

WorkersCompensation.com, March 5, 2019

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.

A twist on an opioid lawsuit

Crain’s Chicago Business, October 16, 2018

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 survey says workers’ comp drug spend has decreased by over $1 billion in the past eight years

News Release, July 11, 2018

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

CompPharma’s President Joe Paduda to Testify before Congressional Subcommittee on Opioids

News Release, May 7, 2018

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

Paduda: Chronic opioids can be solved

Work Comp Central, October 12, 2018

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.

Read More (Subscription required)

Experts question motive behind changes to California comp drug formulary

Business Insurance, September 12, 2018

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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Survey: Workers’ Comp Drug Spend Declined by $1B in Past 8 Years

Claims Journal, July 18, 2018

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.

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A Billion Dollars and Better Care

WorkersCompensation.Com, July 16, 2018

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.

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Pharmacy no longer fastest growing segment in comp spend: Study

Business Insurance, July 11, 2018

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.

Read More (Subscription may be required)

Injured feds are at higher risk of opioid addiction.

Federal Times, May 8, 2018

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.

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Opioid Addiction by Federal Workers Examined by House Panel

Bloomberg, May 8, 2018

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.

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New Dosages of Old Drugs Are Used to Raise Their Prices

New York Times, February 25, 2015

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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Physician Dispensing & Opioids Still Major Concerns, Compounds an Emerging Issue

WorkCompWire, December 17, 2014

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.

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CompPharma Research on Compounded Drugs Questions their Efficacy, Safety and Cost

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

To see if we’re a good fit, contact
Joe Paduda at
203-314-2632
or
jpaduda@comppharma.com