Author: Julie Ferguson

2017 Prescription Drug Management in Workers’ Compensation

2017 Prescription Drug Management in Workers’ Compensation (PDF)
The Fourteenth Annual Survey Report (2016 data)

Over the last seven years, workers’ compensation prescription drug costs have decreased by approximately one billion dollars. Prescription drugs have long been a critical issue in workers’ compensation. Accounting for one of every seven medical dollars, pharmacy’s impact on patient recovery, disability duration, return to work, and claim settlement outweighs the benefit’s dollar expense. Each year pharmacy is the subject of much research on the part of such august organizations as the California Workers’ Compensation Institute (CWCI), National Council on Compensation Insurance (NCCI), the Workers’ Compensation Research Institute (WCRI), and others. The purpose of this survey is to add depth to our understanding of the issue, supplementing statistical and systemic research by adding the perspectives and data of state funds, insurers, third-party administrators, and self-insured employer.

Business Insurance – Opioid reserves in Medicare set-asides a nationwide problem

Researchers in California were the first to quantify how many Medicare set-asides had money earmarked for opioids — 70% of closed workers compensation claims in California include cash for future pain prescriptions, they found — but experts say the problem is a national issue.

“I start to think we are making progress and we are getting somewhere and opioid use in comp is down, and then you come across something like this,” said Alex Swedlow, president of the Oakland-based California Workers’ Compensation Institute. “It’s extremely frustrating.”

Continue reading: Opioid reserves in Medicare set-asides a nationwide problem

WorkCompCentral – Paduda: Opioids, MSAs and the Feds

According to the California Workers’ Compensation Institute, the average California Medicare set-aside includes almost $49,000 for drugs — about half of all future medical expenses.

Sixty-nine percent of MSAs included funding for opioids.

But when researchers compared the MSAs to a “case-matched control group of closed workers’ comp permanent disability claims for similar injuries, the authors found that the WCMSAs called for much stronger opioids, as average cumulative morphine milligram equivalents (MMEs) allocated to WCMSAs with opioids were 45 times the level used in the control group during the life of the claim.”

Continue reading: Paduda: Opioids, MSAs and the Feds

2017 Compounds in Comp: A New Look at Patient Safety, Efficacy and Cost

2017 Compounds in Comp: A New Look at Patient Safety, Efficacy and Cost (PDF)

CompPharma published “Compounding is Confounding Workers’ Compensation” in 2014. That research paper, like this one, was written by pharmacists and government affairs professionals employed by several of the member pharmacy benefit management (PBM) companies of CompPharma. Many of the pharmacists who worked on both papers have extensive training and experience in the art of pharmaceutical compounding.

The original paper was well received by the workers’ compensation community, and over 2,000 copies have been downloaded from the CompPharma website as well as those of the member companies. In addition, the paper was presented at several industry forums including the International Association of Industrial Accident Boards and Commissions (IAIABC) and the American Insurance Association (AIA).

However, the paper was not well received by a few pharmacists who interpreted it as an attack on both the necessity and the science of state-of-the-art pharmaceutical compounding

Los Angeles Times – The Trump administration’s bogus claim about Obamacare and workers’ comp

<excerpt> Ahem. Obamacare, formally known as the 2010 Patient Protection and Affordable Care Act, was utterly silent on workers’ compensation insurance. None of its provisions applied to that specialized market. And to the extent it had an indirect effect on workers’ comp, it helped hold down claims and insurance premiums, according to Joe Paduda of Health Strategy Associates, a former insurance execuwho specializes in workers’ comp issues. Since the ACA was fully implemented in 2014, Paduda wrote, the medical trend rates (the annual increase in claims for medical care) in workers’ comp have been historically low, a “strong indication that [the] ACA is a major factor in lower work comp costs.”

Continue reading: The Trump administration’s bogus claim about Obamacare and workers’ comp

2016 Prescription Drug Management in Workers’ Compensation

2016 Prescription Drug Management in Workers’ Compensation (PDF)
The Thirteenth Annual Survey Report (2015 data)

Prescription drugs have become a key factor in workers’ compensation. Accounting for one of every six medical dollars, pharmacy’s impact on disability duration, return to work and claim settlement outweighs the benefit’s dollar expense. Each year pharmacy is the subject of much research on the part of such august organizations as the California Workers’ Compensation Institute (CWCI), National Council on Compensation Insurance (NCCI), the Workers’ Compensation Research Institute (WCRI), and others. The purpose of this survey is to add depth to our understanding of the issue, supplementing statistical and systemic
research by adding the perspectives and data of insurers, third-party administrators (TPAs), and self-insured employers.