Call or email us anytime
(805) 484-0333
Search Guide
Today is Thursday, March 28, 2024 -

Industry Insights

Paduda: Transparency in Drug Pricing

  • National
  • -  0 shares

One of the top issues in work comp pharmacy — heck, in all pharmacy — is transparency.

Joe Paduda

Joe Paduda

More than half of the 27 respondents to our latest survey of pharmacy management in workers’ comp want more transparency, while several others “need more transparency as I don’t feel comfortable not knowing if pricing is fair.”

The question is, what exactly is transparency?

Is it the customer knowing what the pharmacy benefit manager paid for the drug?

What about rebates?

Is it knowing what the pharmacy “charged” the PBM for that drug (which may or may not be what was paid)?

What about MAC pricing (maximum allowable cost), where the PBM fixes the price it pays for a type of drug — say, ibuprofen 800 milligrams — at a flat rate regardless of the drug manufacturer’s average wholesale price (there are lots of companies making ibuprofen 800 milligrams)?

Net “transparency” isn’t quite transparent.

What does this mean for you?

If you are evaluating PBMs, make very sure you understand exactly how they define transparency. The best way to compare is to have them reprice specific drugs from the same pharmacy dispensed on the same day.

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.

No Comments

Log in to post a comment

Close


Do not post libelous remarks. You are solely responsible for the postings you input. By posting here you agree to hold harmless and indemnify WorkCompCentral for any damages and actions your post may cause.

Advertisements

Upcoming Events

  • May 13-15, 2024

    NCCI's Annual Insights Symposi

    Join us May 13–15, 2024, for NCCI's Annual Insights Symposium (AIS) 2024, the industry’s premier e …

  • Jul 29 – Aug 2, 2024

    76th Annual SAWCA Convention

    SAVE THE DATE! 76th Annual SAWCA Convention July 29 – August 2, 2024 Hotel Effie Sandestin 1 Grand …

  • Aug 14-17, 2024

    CSIMS 2024 Annual Dual Track C

    California Society of Industrial Medicine and Surgery (CSIMS) is combining its two conferences, PI …

Workers' Compensation Events

Social Media Links


WorkCompCentral
c/o Business Insurance Holdings, Inc.
PO Box 1010
Greenwich, CT 06836
(805) 484-0333