Joe Paduda provided insight into the Injured Worker Pharmacy (IWP) business model for Boston Globe Reporter Felice Freyer’s article: Andover Pharmacy under investigation for opioid dispensing.

WorkCompCentral, April 30, 2019

Joe Paduda questioned Optum’s industry trend report’s suggestion that there may be a shift from meds to physical therapy and other ancillary services.  He told Elaine Goodman, that just because spending for durable medical equipment or physical therapy went up while drug costs went down doesn’t mean one caused the other.  “Moreover, we don’t know if DME spend is higher due to adjusters using Optum DME for more complex patients, or Optum’s prices for DME are higher,” Paduda said. “The report provides no data to support the inference that drugs are being replaced by other services.”

See more (subscription required)

WorkersCompensation, March 13, 2019, Paduda to make the case for single-payer healthcare.

Joe Paduda will discuss the impact of “Medicare for All” on work comp when he delivers the keynote at the California Self Insured Association annual conference on April 8.

Paduda turned the focus of the session to drug compounding. He noted that while physician dispensing and compounding are different issues, they are both driven by the same financial motivation.

He explained that drug compounding is the preparation, mixing, assembling, packaging or labeling of a drug. There are valid reasons for using compounding drugs, including patients that may be allergic to a binder in standard medication, patients with swallowing issues and children who may require a smaller dose. According to Paduda, compounded drugs account for less than 1 percent of prescriptions in the country.

Continue reading: Workers’ Compensation Still Under Pressure from Drug Repackagers, Compounding Pharmacies

Though the number of physician dispensed prescriptions declined considerably from just a few years ago, the workers’ compensation industry continues to battle an adapting market seeking to maintain high prices by changing drug strength and formulations.

The impact of physician dispensed pharmaceuticals and drug compounding on workers’ compensation systems nationwide was highlighted recently during a session hosted by the National Conference of Insurance Legislators’ Workers’ Compensation Insurance Committee at its annual meeting held in Phoenix, Arizona.

Continue reading: Drug Repackagers, Compounding Pharmacies Continue to Stress Workers’ Comp Systems

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

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

<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