Insight, analysis & opinion from Joe Paduda
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 … Continue reading NY’s new WC Rx fee schedule
Read More...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, … Continue reading PBMs and retail pharmacies
Read More...If you want to know why you are getting more physician bills with meds on them, it’s simple – physician dispensing generates big profits.
Read More...The two major third party billers have been on the block for a few months. The first round of queries went out to financial buyers and lately they’ve opened the process up to potential strategic buyers as well. Why?
Read More...AWP has long stood for “ain’t what’s paid”, and the old saw has been validated by documents made public during litigation in Boston earlier this year. First DataBank, one of the publishers of Average Wholesale Price data, had been sued … Continue reading What’s happening with AWP?
Read More...My firm’s third annual survey of prescription drug management in workers comp has been completed, and here are a few of the findings. 1. Drug costs increased slightly more than 10% last year, a “decrease in the rate of increase” … Continue reading Drugs in Workers Comp – Survey Report
Read More...For the dozen folks who find this remotely interesting – A few factoids and interesting tidbits from around the WC PBM world. The legislative efforts in California to address repackagers and dispensing of drugs by physicians appears to be stalled, … Continue reading Work comp drug talk round 2
Read More...The law of unintended consequences continues to dog the much-maligned Part D program. So far, seniors and states have been depicted as the primary victims of the program’s operational, structural, and marketing faults. Now there’s news that the program’s impact … Continue reading Pharmacists, Part D, and politics
Read More...Physicians and clinics are finding that dispensing drugs to patients can be a very profitable venture. Advocates are claiming that the practice improves the quality of care and ensures the patient receives the necessary scripts. Let’s take the quality of … Continue reading Repackagers’ margins
Read More...From Jim Andrews of Cypress Care comes a heads-up of an article by a former California state representative who’s endorsing the doctor-dispensing trend, noting that it has “small costs and huge benefits.” Perhaps to his consulting clients, who include the … Continue reading Repackagers and the myth of AWP
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