The manufacturer of oxycontin agreed to pay $20 million in penalties for encouraging docs to prescribe the drug more often than approved by the FDA.
And that’s just for starters.
May
16
Insight, analysis & opinion from Joe Paduda
Category: Workers Comp
May
15
Workers comp financials are getting better and better, although more and more that’s due to California.
May
7
I met with quite a few managed care execs at RIMS, as well as several network vendors. There’s a disconnect between the two groups.
May
4
Actiq has hit the big-time.
Newsweek’s latest edition will feature an article on the off-label prescribing of the highly potent narcotic lollypop, an article noting that as much as 80% of scripts for Actiq are for off-label use.
Sources indicate this was brought to the reporter’s attention by an unusual source – the risk management department of The Washington Post, Newsweek’s sister publication, noticed a high incidence of Actiq scripts among its workers comp patients, and started digging into the issue.
May
2
Pharmacy chains demand higher payment for workers comp scripts. WC takes more work, as the pharm tech has to determine eligibility and do more work to get a script processed. Therefore, it’s logical that the chains charge more for WC.
Except that isn’t what’s happening.
May
2
Dozens of brand spanking new workers comp pharmacy benefit managers (PBMs). Last year at RIMS every aisle was packed with shiny new booths staffed by folks who, as swiftly became painfully obvious, were rather new to WC.
Either they didn’t want to come to New Orleans (they are definitely missing out) or they are out of business, or out of the comp business. Most likely they found their group health contracts, systems and processes, and cost management techniques just didn’t work in the highly-regulated, state-specific, first-dollar-every-dollar world of WC.
We’ll miss their enthusaism and humor-generating ability (“and how many members do you have? what kind of tiered copays are you using? let me tell you about our unique formulary that controls costs!”) and trinkets.
Sort of.
May
1
Coventry released their earnings report last Friday and hosted a “get to know the new workers comp team” event at RIMS last night. Here are the take-aways.
Apr
26
Just to be clear, I’m talking about the ones used in spine surgery, bone and joint surgery, and other orthopedic procedures. The use of surgical implants has grown dramatically, as have their prices, and the impact of utilization and price means big bucks for WC payers.
Big bucks as in $72 million in California alone. As in adding 11% to 33% to inpatient hospital bills in the Golden State.
Apr
25
A scientific study supports what claims adjusters and case managers have known for years – obese workers incur more workers comp claims and cost way more and are much harder to get back to work than their skinnier colleagues.
Three audits I’ve conducted over the last six months confirm the stats with anecdotal evidence.
Apr
18
OK, another trip down Esoteric Lane, into the wierd world of WC drug management…
When states set high workers comp fee schedules for drugs, WC medical costs go up, and too many dollars are taken from employers and given to pharmacies and PBMs.
That’s exactly what an organization with the seemingly innocent title “Workers Comp Pharmacy Alliance” is working towards.