Insight, analysis & opinion from Joe Paduda
There’s a good bit of activity on the regulatory front as states with work comp pharmacy fee schedules consider possible changes to address the myriad issues inherent in AWP. A little background will help frame the issue. First, it’s important … Continue reading Should Medicaid be the basis for work comp drug fee schedules?
Read More...There’s a bit of confusion in the comp pharmacy management space, as there appears to be contradictory evidence from two respected sources about the use of narcotic opioids in workers comp. First, everyone agrees there’s just far too many claimaints … Continue reading Narcotic usage in workers comp – what’s really going on?
Read More...As CMS seeks to ensure taxpayers don’t pay for care due to comp, liability, or other causes, Medicare Set-Asides will become more common. And as we’ve seen recently, one of – if not the – biggest cost areas is pharmaceuticals. … Continue reading Medicare Set-Asides – the real problem
Read More...This morning ended with Medco’s annual Drug trends report, which focused on their top 200 clients that account for the vast majority of Medco’s annual spend. As one of the big three PBMs (along with Caremark/CVS and Express Scripts), their … Continue reading Drug cost inflation 2009 – generally under control…except prices
Read More...When you get a call late on a Friday, it’s usually good news – if it was bad, they’d usually wait till Monday rather than ruin your weekend. The call I received from Kent Takemoto, MD, President of PMSI Settlement … Continue reading Good news on a Monday – CMS’ change in MSA ‘accounting’
Read More...In the very narrow world of work comp managed care, there’s an even skinnier slice focused on managing pharmacy. As pharma accounts for almost a fifth of all medical dollars spent in comp, its an area that certainly deserves attention … Continue reading Texas’ efforts to control WC Rx
Read More...To no one’s surprise. work comp medical costs appear to be on their way up, and at a rate significantly higher than the medical CPI. First the what, then the why. The latest data from NCCI indicate comp medical inflation … Continue reading Work comp medical costs – heading up…
Read More...Last week’s announcement that the FDA is considering requiring physicians’ to obtain additional training in order to prescribe certain Schedule II narcotics is welcome news – for payers and patients. Physicians aren’t so welcoming. The list of drugs includes several … Continue reading FDA’s limits on prescribing of narcotics
Read More...Regulators are increasingly seeking politically low-cost ways to reduce workers comp costs. Some have decided to use the Medicaid reimbursement rate for drugs for Workers Comp, evidently figuring that if pharmacies accept it for Medicaid, they’ll do the same for … Continue reading Why Medicaid Rx reimbursement rates don’t make sense for Workers Comp
Read More...Jim Andrews of Cypress Care (a consulting client and WC PBM) gave a talk yesterday about some of the differences between drug spend in WC and group health. Here are a few of the main points I picked up.
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