Paduda: Work Comp Pharmacy Week

Wednesday, September 7, 2022 | 1

There’s been a lot of news around work comp pharmacy of late. Time to dive into what’s happening, why, and the implications thereof.

Joe Paduda

No better place to start than Workers Compensation Research Institute's just-published study on the latest in drug trends across 28 states. (Register here for the no-cost webinar at 2 p.m. Eastern Sept. 29).

The research looked at trends over the three years from Q1 2018 to Q1 2021 (kudos to WCRI for getting this very recent info out quickly).

Key takeaways from Dongchun Wang, Vennela Thumula and Te-Chun Liu’s research include:

• Prescription payments (all figures are per claim) dropped 15% or more in almost two-thirds of the 28 states but went up in Connecticut (22%), Florida (17%) and Pennsylvania (14%). Hmmmm.
• Notably, a major driver of the increase in those states was dermatological agents, driven by physician dispensing and/or mail order pharmacy dispensed drugs in those three states (and others).
• COVID is a non-factor; COVID claims account for less than 2% of total Rx costs in most states.
• Other good news: Opioids continued to decline in all 28 states, A LOT. As in a decrease of 56% in the median state.
• The biggest drop in spend occurred in New York, a 43% decrease driven by the adoption of a formulary in early 2020.
• The range in spend is really striking. As of Q1 2021, the lowest state spend for claims with any medical spend was $22 (Massachusetts, Minnesota, Wisconsin); the highest was almost 10 times higher in — you guessed it — Florida, at $201.

States that enable/allow/don’t prevent abusive prescribing and dispensing — looking at you, Connecticut, Georgia, Florida, Louisiana, Pennsylvania, South Carolina and others — are allowing grifters and thieves to steal money from employers and taxpayers while overtreating patients. 

Lotions, aka dermatological agents, are almost entirely a (pick your term) that are enabled and perpetrated by physician dispensers and some mail order pharmacies, and by the lack of aggressive and useful action by employers and insurers and their lobbyists.

Forecast

Insurers, employers and taxpayers in those states are going to get hammered by these bad actors. Costs for dermatological agents rose more than 50% in Pennsylvania, Connecticut, South Carolina, Florida, Georgia, Virginia, North Carolina and Michigan.

Given the lack of an effective response by payers, their lobbyists and government affairs entities, you can expect more of the same.

What does this mean for you?

Great work on the opioid front, although just slashing opioids is not THE solution to pain; this requires a multi-pronged approach.

As for dermatological agents, do you like getting screwed by profiteers?

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.