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Paduda: Three Things About Work Comp Drugs

  • National

After a long and litigious delay, myMatrixx has been awarded the contract to manage pharmacy benefits for the coal and energy programs run by the Department of Labor’s Office of Workers’ Compensation Programs (OWCP). Details of the case, which involved a protest by rival Optum, are here.

Joe Paduda

Joe Paduda

That’s the good news (the feds should have had a pharmacy benefits manager running these programs years ago).

Now, the bad news.

The press continues to dive into the audit of the other OWCP program, the Federal Employees' Compensation Act, which provides workers’ comp to all federal employees.

The latest is from Leslie Small of AIS Health. From Small’s piece:

  • “OWCP has been doing a poor job of both controlling the FECA program's spending on prescription drugs and implementing its own policies to ensure that prescriptions are being appropriately dispensed, said the OIG report."
  • OWCP published a bulletin in 2011 that forbid reimbursement for fast-acting fentanyl prescriptions unless claimants had been diagnosed with a certain type of cancer … during the audit period … 98.7% of the fast-acting fentanyl scripts that OWCP (and taxpayers) paid for "went to claimants without evidence of one of the eligible cancer diagnoses.” 
  • "Even more troubling, if that’s possible, is that OWCP did not institute controls to mitigate opioid usage until the end of 2016, years after many commercial insurers, third-rate administrators and large employees had done so."

Here’s hoping this much-needed attention results in even-more-needed improvements (my opinion only).

Drug costs in California are getting well-deserved attention again; the California Workers’ Compensation Institute's research identified nine drugs — three each opioids, dermatologicals and antidepressants — that account for a significant percentage of total drug spend. CWCI members can get the full report at no cost; it’s $18 for others.

Branded antidepressants (tapentadol/Nucynta) and the three antidepressants make up a small percentage of scripts but a big percentage of dollars.

Of course, in the vast majority of cases, the dermos are just BS drugs that should never be allowed.

What does this mean for you?

Don’t sleep on pharmacy. Sure, costs are down, but it still has a major influence on recovery, return to work and claim closure.

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.

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