Insight, analysis & opinion from Joe Paduda

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Aug
27

Friday update

Sorry loyal readers – been swamped w a big project; auditing the Federal work comp program’s pharmacy program.

Here’s what happened this week while I was immersed in data, workflows, job descriptions, reports and contract terms.

COVID

Florida – from colleague, master fisherman and good friend David Deitz MD PhD came thisanticipating more deaths among the unvaccinated, Florida hospitals are renting refrigerated trucks for temporary morgues.

The Sunshine State isn’t the only state with hospitals anticipating more deaths due to vaccine stupidity. Texas and Kentucky hospitals are also lining up rental trucks…

Most insurers are ending waivers for patient copays/coinsurance for COVID treatment. This means those who do have to get care  – or their heirs if that care doesn’t save their lives – may well face ginormous bills for treatment.  From Kaiser Health News:

 there’s logic behind insurers’ waiver rollback: Why should patients be kept financially unharmed from what is now a preventable hospitalization, thanks to a vaccine that the government paid for and made available free of charge?…

A harsher society might impose tough penalties on people who refuse vaccinations and contract the virus. Recently, the National Football League decreed that teams will forfeit a game canceled because of a covid outbreak among unvaccinated players — and neither team’s players will be paid.

But insurers could try to do more, like penalizing the unvaccinated. And there is precedent. Already, some policies won’t cover treatment necessitated by what insurance companies deem risky behavior…

I’m all in favor of personal responsibility – and no COVID isn’t the same as addiction treatment or lifestyle issues.

Those damn topicals

Topicals and compounds just won’t go away…Mostly because profiteering fraudsters are adept at figuring ways around regulations, insurers’ prior authorization requirements, network contract language, and system edits.

WCRI’s has just published a very useful report on the issue; this data point really got my attention:

payment share for topicals in the typical state increased from 9 percent in the first quarter of 2015 to 19 percent in the first quarter of 2020.

And don’t miss WCRI’s Dr Vennela Thumula and Te-Chun Liu research on off-label use of gabapentinoids, one of the other fast-growing and highly-questionable prescribing practices so damn common in work comp.

What does this mean for you?

Get vaccinated, and be very careful if you live in an area with a low vaccination rate.

And check your drug spend reports for topicals and gabapentinoid utilization. If your PBM can’t help you, get another PBM. 


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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