Category: Manage Care – Group Health

Jan
23

Warning on Fentora

Posted by Joe Paduda on Wednesday, January 23rd, 2008 | Comments

The FDA has issued a warning notice for off-label use of Fentora after three deaths were linked to off-label usage of the fentanyl tablet.
One issue may be related to the substitution of Fentora for another powerful pain medication, Actiq. Both are manufactured by Cephalon, but Fentora is absorbed more quickly than is Actiq. Therefore, the same dosage of Fentora may result in more of the drug being absorbed into the bloodstream.
Cephalon has been plagued by accusations of aggressive detailing, including encouraging physicians to prescribe the drug off-label. Another recent article indicates the pharma industry has been aggressively lobbying the FDA to allow this type of detailing, which evidently has been going on for two years despite restrictions against the practice.
Of note to workers compensation insurers, Fentora appears to be becoming increasingly popular for treatment of back pain in some areas.
What does this mean to you?
If you are a WC payer, find out which claimants are taking Fentora and figure out why and if it is appropriate. Not only is the drug dangerous, it is also very expensive.

Dec
14

ASCs — good, bad, or just ugly?

Posted by Joe Paduda on Friday, December 14th, 2007 | Comments

A recent court ruling in New Jersey could shut down Ambulatory Surgical Centers across the state.
The judge determined that physician-owned ASCs (almost all ASCs are at least partly owned by physicians) violate a state law banning physician self-referral. Not surprisingly, the 200 ASCs in the Garden State (there are about 5000 nationwide) are pulling out the stops to overturn a ruling that, if it stands, would effectively shut down most ASCs in NJ.

Continue reading ASCs — good, bad, or just ugly?

Dec
10

The return of 24 hour coverage?

Posted by Joe Paduda on Monday, December 10th, 2007 | Comments

A decade ago a lot of folks were working on ’24 hour’ coverage – the combination/integration of workers comp and group health and disability management. AIG, United Healthcare, Reliance National, Broadspire (nee Kemper) and Unisource Administrators were among the players; the Integrated Benefits Institute was founded, and consultants formed practices and marketed their expertise to interested parties. (disclosure – I was heavily involved in the AIG-UHC, Reliance-UHC, and Unisource-UHC-AIG programs)
Then it all sort of faded away, and not much was heard until today’s announcement that Sedgwick CMS and UHC have re-entered the market.

Continue reading The return of 24 hour coverage?

Nov
28

Suit day

Posted by Joe Paduda on Wednesday, November 28th, 2007 | Comments

Today’s a “suit day”; one of those increasingly-frequent days where business demands require something a bit more upscale than the usual. Today’s event is the Piper Jaffray Healthcare Investor conference in NYC, where I’m on a panel discussing Consumer-directed health care with Jeff Margolis of TriZetto and John Mills of HIP.
We’re slated to discuss the role of consumerism in healthcare’s future, in front of an audience comprised of investors and analysts.

Sep
26

Why the good news on Employer health care costs?

Posted by Joe Paduda on Wednesday, September 26th, 2007 | Comments

It looks like employers’ health care costs will increase by somewhere in the mid-to-high single digits next year. According to one survey, costs for employer-sponsored health insurance will average over $9300 per worker next year. That’s just 7% more than this year, which is ‘good news’. Another report indicates costs will jump by 8.7% to $8600+ per worker. (the disparity appears to be due to differences among survey methodology and subjects, the Towers study focuses on larger employers while the Hewitt data is from health plans).
If the good news continues, health care costs will be $18,600 per employee in ten years.

Continue reading Why the good news on Employer health care costs?