Insight, analysis & opinion from Joe Paduda
Aetna will be Coventry’s workers comp network in 19 states. As I reported last week, the deal replaces Coventry’s underperforming networks with AWCA’s offering, strengthening Coventry’s lead in the WC managed care business while eliminating it’s toughest competitor.
Continue reading It’s official – the Coventry/Aetna deal is done
Depends on who you listen to. I finally got around to listening to the August quarterly conference call re earnings, and the picture is rosier-than-rosy. The TPA acquisitions are paying off handsomely, earnings are up, new technology is driving up margins, and the new CEO is doing a great job.
Aetna and Coventry are negotiating a deal whereby Coventry’s WC customers would gain access to the entire AWCA network thru Coventry. While parameters could change (or the thing could fall apart entirely), multiple sources indicate the AWCA network would replace most or all of the Coventry network offering (in those states where AWCA is viable).
This would represent a sea change for many payers, and yet more consolidation of power at Coventry.
Continue reading Big doings in the workers comp network business
Managed care execs at WC payers are getting increasingly nervous, and well they should be.
There are major changes afoot in the WC managed care market. The consolidation at the top means that changes in policy and practice by the industry leader(s) is likely to have much more impact today than last year. And if that consolidation continues, customers and providers alike may find themselves with even less bargaining power.
Continue reading Is the WC PPO marketplace becoming a monopoly?
My firm has conducted a survey of pharmacy benefit management in workers comp each year for the past four, and the latest has been completed. Executives in managed care and claims as well as program managers from 20+ payers responded to the Survey, some for the fourth time.
Here are a few of the highlights.
Continue reading Pharmacy benefit management in Workers Comp – Survey results
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.
Back and neck injuries account for a third of all workers comp claims costs. That’s no surprise to industry types, and is a further affirmation of how tough it can be to manage comp claims.
Back injuries can be notoriously difficult to resolve, expensive to treat and impossible to determine if a back injury was related to employment.
If you’re wondering why your company’s drug costs are going up, one likely contributor is the dramatic increase in the use of pain medications. Retail sales of five leading pain drugs jumped 90% from 1997 to 2005 led by oxycodone’s six-fold increase.
The NY WC reforms are going to significantly reduce workers comp premiums –a point that many of the legislation’s critics are all but ignoring.
Restaurants, dry cleaners, and health clubs will see a 40% reduction; nursing home premiums will drop 37%, tool manufacturers 38%. These cuts will improve the viability of these businesses, and in the case of manufacturers, potentially keep jobs in the Empire State. Nursing home margins have been suffering for several years; WC premiums are a significant cost so the reform is quite meaningful.
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.