Medical Foods and Workers' Comp
Wednesday, August 25, 2010 | 0
By Joe Paduda
CompPharma and Health Strategy Associates
The good folks at the California Workers' Compensation Institute just published a research report (The Cost and Utilization of Compound Drugs, Convenience Packs and Medical Foods in California WC) documenting the rise in spend on medical foods, repackaged drugs, and compound drugs from 2006 to 2009; the highlight is these categories accounted for almost 12% of drug spend in California in the first quarter of 2009.
A couple of the findings that jumped out at me:
- The average amount paid per compound drug as $728 in Q1 2009.
- Medical food reimbursement hit $233 per script that quarter
- A new category, 'co-packs' has emerged as a significant therapy; these are combinations of drugs with medical foods dispensed as a single unit.
- A drastic reduction in the fee schedule was followed by explosive growth in repackaged drugs.
- Regulatory changes finally addressed that issue, but meanwhile the use of narcotic opioids increased six-fold, likely negatively impacting disability duration as well as increasing cost.
- New entrants into the therapeutic armamentarium, entrants that are foreign to many adjusters, case managers, and work comp execs alike, are growing in importance, requiring regulators and payers alike to understand their impact and develop policies for coverage and reimbursement.
I'm no pharmacist or clinician, and am certainly not able to comment on the efficacy of medical foods or specific medications. For a primer on medical foods, click here.
There does appear to be evidence supporting the use of medical foods for treatment of pain, osteoarthritis, and other conditions, with one medical food, Limbrel, the subject of large, double-blind, placebo-controlled clinical studies in the United States and Japan. According to one source, "Limbrel administration has resulted in statistically significant improvement in all primary clinical endpoints (functional mobility, functional stiffness and functional joint discomfort)."
What does this mean for you?
If your pharmacy and therapeutics committee hasn't looked at medical foods yet, you may want to add it to the agenda for the next meeting. It is highly likely we're going to see more of these scripts, and far better to be ready than to have your adjusters making decisions completely unprepared.
Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, a Connecticut-based employer consulting firm. This column was reprinted with his permission from his blog, http://www.managedcarematters.com.
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