Here’s a shocker – quoted from a FierceHealthcare piece last November.
“oncologists accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S. during the first six months of 2006, The Wall Street Journal reported.”
Actiq is only FDA approved for breakthrough cancer pain.
My firm’s research indicates that Actiq is among the top three drugs in dollar volume dispensed to workers comp patients. The incidence of cancer in WC is so low as to be unmeasurable.

We’re getting a clearer picture of the implications of NY’s adoption of a (very low) fee schedule for WC prescription drugs. As I’ve noted before, the WCB has clearly stated its opinion that the regs do not allow for reimbursement above the fee schedule.
The initial reaction to the news from several large pharmacy chains (at the National Association of Chain Drug Stores conference in Boston) ranged from disappointed acceptance to belligerent rejection.

Continue reading The NY WC Rx Update

The recent imposition of a work comp pharmacy fee schedule in New York has shaken the industry – and that’s not hyperbole. The latest news out of Albany is likely to intensify the aftershocks.
The preliminary guidance from the State is PBMs cannot charge more than the fee schedule, and cannot pay pharmacies more than the fee schedule.

Continue reading NY’s workers comp fee schedule – further developments

New York’s new fee schedule for drugs dispensed to workers comp claimants is among the lowest in the nation.
How low?

Continue reading How low is the NY WC Rx fee schedule?

The regulators in NY have decided that drugs for work comp claims will be reimbursed at the Medicaid fee schedule plus a dispensing fee.
That is a huge change from the prior reimbursement level of usual and customary, which in the Rx world is defined as the actual cash price in that pharmacy for that drug on that day.
Here’s the legal language.

Continue reading NY’s new WC Rx fee schedule

From the big big world of national health care reform, we’re heading to the tiny niche of drugs in workers comp, where some pretty interesting things are happening.
Well, interesting to the six or eight people who are remotely interested in WC drug management.

Continue reading It’s utilization!

My post on the efforts by WCPA and others to roll back parts of the NY workers comp reforms has generated a lot of criticism by individuals who appear to consider themselves advocates for the injured worker.
My motives, intelligence, experience, and perspective have all been questioned, with varying degrees of civility. The personal assaults are not helpful nor are they constructive.

Continue reading PBMs and retail pharmacies