Jul
14

Latest data on WC drug spend, opioids, generics and PBM ratings

27 payers were kind enough to participate in this year’s Annual Survey of Prescription Drug Management in Workers’ Compensation.  I’m working thru the data now…here are a few highlights. (The Survey falls under CompPharma, a workers’ comp pharmacy consultancy; as always, responses are confidential and not shared with anyone or any entity)

Overall, pretty darn positive (but premature as some data is still coming in) results…

Opioids

Across all 27 respondents, opioids accounted for 18.7% of drug spend, a drop of half a point over the last 2 years.  That’s good news indeed…but there are caveats which we will get into in a future post.

One thing to note – there was a good bit of concern last year that the COVID thing might/would increase opioid usage; that didn’t happen. Again, good news.

Drug spend 

Overall drug spend decreased 12.3% from 2020 to 2021; about half of the respondents attributed the drop at least in part to fewer claims. In turn, most tied the drop in claim count to COVID.

Over the last decade, work comp pharmacy costs have dropped 9 out of the ten years.

Generics

Generic drugs accounted for 89.3% of all scripts, with generic efficiency ( the percentage of all drugs dispensed as generics that could have been generics) averaging just under 98%.

Again, an improvement over 2018’s 87% generic fill percentage.

PBM ratings

Once again respondents rated myMatrixx as the top PBM with 3.7 out of a possible 5 points, with market-share leader Optum trailing by a half-point. Mitchell is tied with Optum, while Coventry’s First Script lags another half-point behind. (Mitchell recently acquired Coventry)

Again, data is preliminary and subject to change.

More to come; as always a big thank you to the respondents who will each received a detailed copy of the Survey report; a public version will also be prepared and available at no cost to all.

Note – myMatrixx is an HSA consulting client; myMatrixx was not involved in conducting the Survey.


Jul
12

I haven’t seen any proof that it isn’t…and, well, if one believes the Left is a secret cabal of demons chasing kids, it sure looks like it could be.

Two very interesting data points.

First, residents of counties that voted for Trump are significantly less likely to have been vaccinated.

Same holds true for states…

Second, almost all recent COVID-related deaths are among folks who aren’t vaccinated; fully-vaccinated people account for less than one out of a hundred COVID-related fatalities.

And, the ones who stand to gain if more Trump voters die from COVID are Democrats and Leftists.

Of course this is utter nonsense, but no less nonsensical than accusing Hillary Clinton of leading a child-sex ring headquartered in a pizza restaurant.

What does this mean for you?

Satire has lost its impact.


Jul
8

The Delta Variant – key facts

What you need to know about the Delta Variant

  1. Delta is more transmissible than the original COVID and the Alpha variant.
  2. It may be more dangerous as well; a Scottish study found Delta victims were about twice as likely to be hospitalized than those infected with other COVID versions.
  3. Various studies indicate full doses of the various vaccines are quite effective at preventing COVID infections, reducing hospitalizations and deaths.
    1. Canada – Pfizer is 87% effective.
    2. UK – Pfizer is 88% effective in preventing symptomatic disease; Astra Zeneca 60% effective against symptomatic disease
    3.  Israel – Pfizer 64% effective at preventing infections, 93% in preventing serious problems from COVID infection (note I was unable to locate the actual research; source is the Israeli government.)
  4. Delta is responsible for the vast majority of new cases in the UK.
  5. Countries with relatively low Delta infection rates continue to see declines in overall COVID infections.

What does this mean for you?

Get vaccinated.


Jun
29

You bet your life.

For my friends out there who remain unconvinced COVID vaccinations are a good idea, please think again.

Breakthrough infections – fully vaccinated people contracting COVID – accounted for only about 1 in every 700 hospitalizations.

Put another way, people who haven’t been vaccinated accounted for 699 out of 700 hospitalizations.

A similar dichotomy holds for COVID-related deaths; fully-vaccinated people account for less than one out of a hundred COVID-related fatalities.

Not surprisingly states with lower vaccination rates are seeing higher infection, hospitalization and death rates.

Great source for tracking state-specific data

Arkansas, Oklahoma, and Missouri are among those states likely to experience increases in COVID infections, hospitalizations, and deaths.

There is another factor in play here – unvaccinated people are far more likely to get infected, become a COVID host, and pass their germs on to others. So not only do they risk their own health, they also endanger many more people.

And – and it’s a BIG and – the more people infected, the more likely COVID will mutate and become more transmissible and deadlier. We’ve already seen this with the Delta variant; transmission rates are increasing rapidly especially in the South.

What does this mean for you?

Please – get vaccinated.


Jun
24

The Delta Variant

You are as done with COVID as I am.

COVID is not done with us.

Here in New York’s Finger Lakes everything is open; had a great family night out yesterday, no masks required for those of us fully vaccinated, hiring signs are all over, and the joy that is upstate NY in summer is in full swing.

While we are blissfully enjoying life, the Delta Variant is:

That’s the bad really bad news.

The good news is vaccinations – especially the ones based on mRNA (e.g. Pfizer) are still “spectacularly effective” against the Delta variant. 

As in 96% effective in preventing hospitalizations.

However, that’s after both doses; a single dose is just 33% effective at preventing symptomatic illness.

Here’s the thing. The more of us that get infected, the greater the chance that the damn virus morphs into a deadlier, more transmissible, and thus even bigger problem. So far the vaccines we have are working.

But – and it’s a damn big “but”, far too few of us are vaccinated. That’s particularly true of southern states, where a combination of misinformation,  awful treatment of minorities by some governmental entities and segments of the medical community (the Tuskegee experiment being a prime example) and resulting mistrust, and difficulty with the J&J vaccine have combined to drastically slow vaccination rates.

click here for detailed state-specific data

Here’s a great graphic detailing state progress towards full vaccination…

All this is to say that the fewer vaccinated people there are, the more likely COVID will mutate into something even worse.

What does this mean for you?

Get vaccinated.

Note – if you want to debate or disagree, cite credible sources for your statements. Period.


Jun
17

Thursday catch-up

Doing my best to avoid work on Fridays…so moving this occasional catch-up post to Thursdays…

COVID

Promising news on the effectiveness of a drug to help infected patients fight off the virus was reported by the Economist. The good news – Regen-Cov:

saved the lives of many of those unable to make their own antibodies in response to SARS-CoV-2. Such “seronegative” individuals constituted about a third of the 9,785 hospital patients in the study…compared to a control group given standard treatment … 20% more patients survived

The bad news – it’s stupid expensive, and supply chain issues are hampering production.

A study conducted by the National Institutes of Health indicates COVID may have been in circulation earlier than originally thought. Blood samples from Illinois, MassachusettsMississippi, Pennsylvania and Wisconsin indicate the virus was in those states in December 2019. An earlier CDC study found similar evidence in California, Oregon, and Washington.

These findings indicate a better and more thorough process to identify disease outbreaks may well be warranted.

Comp drugs

WCRI is hosting a timely webinar on Interstate Variations and Trends in WC Drug Payments on June 24. Register here. Gotta say I’m darn impressed by the researchers’ ability to obtain, analyze, and report on payments as recent as Q2 2020. This makes WCRI’s information much more actionable for regulators, clinicians, and payers alike.

Dr. Vennela Thumula and Dongchun Wang of WCRI will be guiding us thru their findings; the webinar is free.

I am finishing up the latest Annual Survey of PBM in WC which will have 2020 and 2019 data; last chance to participate and receive a detailed, respondent-only version of the report. If you want to participate let us know in the comment section below (there’s no cost to participants).

Couple interesting – and very preliminary – takeaways…

  • growing interest in transparency, along with an increased awareness that this isn’t a simple issue.
  • spend continues to decrease, with respondents attributing some of the decrease to COVID.
  • opioid spend continues to drop, but most respondents are still struggling to help chronic pain patients/long-time users of opioids reduce usage.
  • there’s a growing awareness that the PBM pricing model needs to change. With spend declining and a push for transparency, knowledgeable payers understand that paying PBMs less year after year is not sustainable.

Previous public versions of the Survey Report are available here for download at no cost.

 

 

 

 

 

 

 

Hospital pricing

Hospitals are supposed to be publishing their prices – at least Federal regulations require them to. But those smart, sneaky administrators are figuring out all kinds of ways to avoid telling you how much it will cost for that MRI, drug, band-aid, or lung transplant.

From JAMA:

hospitals must publish discounted cash prices (applicable to uninsured patients) and payer-specific negotiated rates. Second, hospitals must display price data, including expected out-of-pocket costs, for “shoppable services” that can be scheduled in advance (eg, office visits) in a consumer-friendly manner that facilitates service-specific comparisons across hospitals (eg, price estimator tools). [emphasis added]

As of early March, only 17 of 100 randomly selected hospitals were complying with the regulations. The penalty for non-compliance is…wait for it…

$300 a day.

Perhaps if the Feds charged hospitals the same way hospitals they charge us, we’d have a bit more compliance. 

How about…the Feds tell the hospitals after the fact what the cost will be, based on a “compliance chargemaster” that takes into account the hospital’s margin, quality scores, number of collection suits it has filed, and medical error rate.

Thanks to the estimable David Deitz MD PhD for the head’s up.

Wellness works

Finally, HealthAffairs reports wellness programs don’t really improve population health, reduce healthcare spending, or improve employment outcomes. 

Almost 40 years ago, I was halfway through a Master’s of Science in Health/Fitness Management when it became obvious this was NOT going to be a lucrative career…quite the opposite. Not saying I was prescient, just that employers sensed this was a nice-to-have and not a got-to-have, and that lack of importance showed in salaries.

Dodged that bullet.

And really finally, congratulations to my favorite baseball team – the White Sox have the best record in baseball after taking 2 of 3 from Tampa Bay. I

know my friends in the Bay area will be heckling me when the Rays surge again…hey, you gotta take advantage of good news when it comes!


Jun
4

Good luck with the truck.

Let’s get real.

You and your kids are driving 80 mph on a highway, when a truck suddenly veers in front of you.  Since you are a quick-thinking insurance person, you estimate your chance of dying if you hit that truck at about 40 percent – just a bit better than even odds.

Or, you can swerve off the road – where your chance of dying is 1 percent – about 1 in 100.

This…

Or this…

What do you do?

That’s the question facing vaccine skeptics.

Vaccine skepticism is driven by memes, misunderstood data, a lack of understanding of basic math, pure laziness, demagoguing, and social media’s incredible ability to publicize nonsense.

Recently I had an electronic conversation where a COVID vaccine skeptic (my characterization, not their’s) cited “publications and VAERS” as sources for their concerns…I don’t know what publications the commenter was referring to; the only reference provided was a 14-month old TV report.

[reminder – if you discuss or debate, provide credible sources – ideally primary source – for your opinions.  Do your homework and don’t be lazy.  If you spout unsupported opinions – looking at you TJ – be prepared to be skewered.]

Leaving that aside, let’s talk VAERS, the vaccine reporting service run by the CDC and FDA. VAERS accepts reports from providers, vaccine recipients (or those who say they had a vaccine, parents, and “others” of any adverse event regardless of proof that it was caused by the vaccine. And VAERS reports can show deaths due to ANY CAUSE – could be drunk driving, hang gliding, heart attack, cancer, whatever.

Want proof ?A few years back VAERS accepted a report of a doc who felt like he was becoming the Incredible Hulk after a vaccination.  

VAERS is often misrepresented by Vaccine Skeptics lying about “problems” and deaths allegedly caused by the vaccine. [Here’s a great review of VAERS reporting issues]

Ok, the data.

VAERS received 4,178 reports of deaths (0.0017% of all who received the vaccine) between Dec. 14, 2020 and May 3, 2021. Remember about 165 million of us have had at least one shot. [source above]

Even if ALL 4,178 deaths were “caused” by a vaccine – and there is ZERO evidence that’s the case –  reality is your chance of dying from a COVID vaccine is far less than getting struck by lightning.

Compare that to your chance of dying from COVID – I ran the numbers here for a 55 year old white man from zip code 92111 with no pre-ex. The risk is .07 percent.

This person is 40 times MORE LIKELY TO DIE OF COVID than from an “adverse event” after you get a Covid vaccine.

What does this mean for you?

Science always wins…or, put another way,

Good luck with the truck.


Jun
2

It’s not about you.

Highly credible data shows today’s infection rate among the unvaccinated is as high as it was back in January.

Remember January?

Shutdown restaurants. Remote “learning”. No family gatherings. No high school sports. No fans at professional sports. No concerts or weddings or parties or fun.

80,000 of our friends, parents, grandparents, colleagues, and loved ones died of COVID in January.

If you aren’t vaccinated, don’t think you’re safe.  You are not. Your chance of getting COVID is the same as it was back in January.

But that’s not the worst of it.  Research shows the variants are more infectious, and in some states this is driving a hospitalization rate double what it was in January.

What does this mean for you>

Unless you don’t care about leaving family, friends, kids, parents, and loved ones with nothing but memories of you, get vaccinated. 


May
27

The latest on work comp pharmacy

I’m almost halfway thru the 17th (!!) annual survey of Pharmacy Benefit Management in Workers’ Comp.  Here are some VERY preliminary results (which are almost certain to change).

If you are a WC payer and want to participate, drop me a note in the Comments section.  Public versions of past surveys are here, respondents receive a much more detailed version.

Findings

All but one respondent saw a drop in drug spend from 2019 to 2020; the biggest cost reduction driver was fewer claims.

Despite a 7+ year trend of declining drug costs, respondents view prescription drug issues as somewhat more important than other medical issues. This is likely driven by drugs’ impact on recovery and return to work.

Transparency remains a significant concern, with only 2 respondents having full visibility into drug costs. Most want more transparency and no one is really comfortable with AWP.

Opioid spend continues to decline...which is the good news.  Not-so-good is the continued problem of helping long-term users reduce or eliminate opioids. Prescriber intransigence is the major obstacle followed by attorneys blocking access to patients.

Few payers have audited their PBM and those that have are (mostly) just checking AWP pricing compliance.

Several noted out-of-state mail order pharmacies – mostly IWP and entities in Pennsylvania – continue to be a sore spot, adding cost, negatively affecting clinical management, and wasting adjuster time.

What does this mean for you?

Costs are down, but pharmacy is about much more than the price of the pill. 

 


May
26

Have work comp payers given up on physician dispensing?

It sure looks like they/you have.

WCRI’s latest report finds:

  • Physician-dispensed drugs (PDDs) accounted for more than half of drug costs per claim in Q1 2020 in four states – Florida, Georgia, Illinois, and Maryland.
  • In 12 states, doc-dispensed dermatological agents accounted for most payments for this drug class.
  • Louisiana is worst-off, with employers paying $190 per claim for dermo drugs in the 1st quarter of 2020…Illinois is right behind at $181.
  • Kansas and Connecticut saw payments for those dermo drugs triple from Q1 2017 to Q1 2020.

That profit-sucking prescribing by docs in Connecticut is why total drug spend increased 30% in the Nutmeg State – making it one of two states that had drug spend increases. Florida – the home state of PDD – was the other. (Across all subject states, drug costs dropped 41%.)

Having lived in CT for over 20 years, I’m really stumped by the precipitous increase in skin care drugs.

What could POSSIBLY be driving this massive need for occupationally-driven skin care/topicals?

Did sun spots create a pandemic of skin cancer but somehow only affect the second-smallest state?

Did a massive refinery accident expose tens of thousands of workers to burns or skin infections?

Did a hyper-virulent new breed of poison ivy run rampant, affecting thousands of landscaping and municipal workers?

Did the emerging cannabis industry fail to protect its workers from fertilizer burns, exposing thousands of workers to painful blisters?

Did everyone in Connecticut suddenly become unable to swallow a pill?

Of course not.

The real question is this:

why haven’t insurers, TPAs, and self-insured employers used CT’s Medical Care Plan to ban physician dispensing? Payers including the Workers’ Comp Trust of CT have pretty much eliminated physician dispensing.

It’s not just Connecticut.  PDD costs are outrageous, and all credible research indicates PDD is totally unnecessary, increases medical costs, and prolongs disability.

WCRI’s research should be a call to action.  Legislators, regulators, and payers are doing their policyholders and clients a disservice by failing to aggressively attack physician dispensing.

And those clients and policyholders are equally at fault – it is up to you to work with your PBM and payer to stop this rampant profiteering. 

What does this mean for you?

Yeah, I know it’s hard. Most important things are. Get to it.