My firm, Health Strategy Associates, is conducting the Third Annual Survey of Prescription Drug Management in Workers Comp, and I’m hoping to have the final report completed before the end of April. Here are a couple of interesting bits that have come up in the 20+ interviews conducted to date.
1. There is a rather striking difference in the pharmacy inflation rate between what I would characterize as less- and more-sophisticated payers. Some payers have held their inflation rates down in the lower single digits, others are seeing trend rates above 15%.
2. Claim frequency decreases get part of the credit for low pharmacy inflation, but not all of it.
3. The number of PBMs is growing, but no PBM has a dominant market position. In fact, many senior execs don’t know much about the PBMs beyond their names.
4. Cost inflation tends to be attributed to more “designer” drugs, e.g. more expensive branded drugs being prescribed when a cheaper generic would likely work; direct to consumer advertising’s impact on consumers, and more claimants getting more drugs for longer periods.
5. This last is probably the most consistent thread running throughout the interviews – a heightened awareness of and concern about the sheer volume of drugs prescribed.
I’ll post additional highlights when they make themselves apparent. If you want a copy of the survey report, email me at jpaduda@healthstrategyassoc.com.
Apr
6
Joe,
My experience with WCB and drugs is such:
Go on drugs
Go on Expensive drugs
Go on drugs not actually approved for a certian condition
Then add drugs that are contraindicated with the drugs you are on.
When the NURSE (who is the person dispensing the advice) is told no because it is a drug that has already been tried at a dose that would take out a horse, it was ineffective, and it is not “indicated for this condition” she has a hissy fit. (I guess that they are the only ones allowed to use their jargon??)
Then she tries to argue.
When pointed out that the other drug is contraindicated with other drugs the patient is using- oops client- she says that it is not valid info.
The drugs she is telling the client to use cost about 3 grand a year.
Silly use of nurse time and resources, and WCB money I think. And why is a nurse essentially prescribing treatment?
What do people who don’t have a clue do?
Oh yeah- they go on the drugs. I know that from the first go around with the same nurse, cuz that is precisely what happened.
Maybe insurance companies should do drug trials, one against another, with proper doses, to see if newer drugs really are better drugs???? And maybe WCB should hire people who know how to read and synthesize information, not just parrots who spout out nonsense that anyone using the internet and consulting a real doctor can figure out is nonsense.
And maybe they should do REAL research and not meta-anlysis studies where the conclusion is reached by consensus, and their results are contradicted by the FDA and proper research.
Just a thought.
Indubitably, the rising cost of drugs in the workers’ compensation arena is due in large part to the prescription practices of the attending physicians. However, the underlying “cost drivers” for workers’ compensation carriers are (1) state fee schedules, (2) weak drug utilization oversight, i.e., waste, and (3) the inexcusable ignorance on the part of state regulators and carriers of how drug manufacturers, and their PBM collaborators, ensure that drugs are always priced at “retail” or “retail” plus the state fee schedule. There are far too few workers’ compensation carriers able and prepared to dissect the pricing games played by the manufacturers and their PBM lackeys. As long as the cost of drugs is less than 20% of total medical costs, who cares if the rate of inflation is 5% or 20% per annum. It is just shameful how much more carriers pay because they won’t challenge the pricing games of the manufacturers or the callous indifference of the state regulators.
Joe, ask your survey participants what they are doing to challenge the cost of drugs at the point where they are manufactured?
Ralph N. Galascione
Dear Mr. Paduda,
Are you aware of a resource for determinging the number of workers comp prescription claims filed annually by state?
Thank You