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Industry Insights

Paduda: The State of Work Comp Pharmacy

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The state of work comp pharmacy is pretty good.

Joe Paduda

Joe Paduda

Here are the very preliminary takeaways from our latest survey of prescription drug management in workers’ comp. So far, 21 phone interviews are completed, and there are several more still to go.

If you’re new to Managed Care Matters, we’ve done an annual survey since 2004. Past public reports are here (respondents get a much more detailed version).

  • Drug spend continues to decline, although at first blush it looks like the drop is less than we’ve seen in recent years.
  • Opioid spend is also continuing its downward trend.
  • Generic efficiency — the percentage of scripts that could be filled with generics that are filled with generics — is just shy of 100%.
  • Payers are still struggling with legacy opioid patients, with respondents identifying patient resistance (mostly fear-driven), recalcitrant prescribers, attorneys and the lack of regulatory/legislative support as key obstacles.
  • Physician dispensing is once again rearing its ugly/profiteering/self-serving/taxpayer-abusing head.
  • Payers want more transparency while fully understanding that pharmacy benefits managers need to make a profit.
  • Topicals seem to be the latest in the scam-o-rama that is the physician dispensing industry.
  • Respondents are generally very open to nonpharmaceutical approaches to pain management (much more on this in a future post).

What does this mean for you?

PBMs and payers, well done. Your work has saved countless lives while helping countless others regain control of theirs.

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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