New York’s new fee schedule for drugs dispensed to workers comp claimants is among the lowest in the nation.
How low?
Jul
18
Insight, analysis & opinion from Joe Paduda
Category: Pharmacy, PBMs, and Pharma costs
Jul
12
The regulators in NY have decided that drugs for work comp claims will be reimbursed at the Medicaid fee schedule plus a dispensing fee.
That is a huge change from the prior reimbursement level of usual and customary, which in the Rx world is defined as the actual cash price in that pharmacy for that drug on that day.
Here’s the legal language.
Jun
28
From the big big world of national health care reform, we’re heading to the tiny niche of drugs in workers comp, where some pretty interesting things are happening.
Well, interesting to the six or eight people who are remotely interested in WC drug management.
Jun
12
My post on the efforts by WCPA and others to roll back parts of the NY workers comp reforms has generated a lot of criticism by individuals who appear to consider themselves advocates for the injured worker.
My motives, intelligence, experience, and perspective have all been questioned, with varying degrees of civility. The personal assaults are not helpful nor are they constructive.
Jun
8
The efforts by third party billers and their partners to overturn a key part of the NY workers comp reform package appear to be gathering strength. Two legislators have introduced a bill that would kill the ability of payers to direct injured workers to specific pharmacies.
The rationale, that the pharmacies would somehow deny scripts, is ludicrous.
Jun
7
If you want to know why you are getting more physician bills with meds on them, it’s simple – physician dispensing generates big profits.
May
22
Pharmacy and Therapeutics committees have been around for ages in the provider community – they are the “link between medicine and pharmacy”. In the managed care world, P&T committees take on a somewhat different role, establishing formularies, reviewing medical device reimbursement (at some health plans), contributing to coverage determinations and benefit design.
Mostly, they provide the health plan or insurer with an expert opinion on most things pharmacy-related. Without a P&T Committee, these decisions often are left to a medical director, or worse, claims adjuster (in the P&C world), individuals who are not equiped to make educated decisions about pharmaceuticals.
May
16
The manufacturer of oxycontin agreed to pay $20 million in penalties for encouraging docs to prescribe the drug more often than approved by the FDA.
And that’s just for starters.
May
4
Actiq has hit the big-time.
Newsweek’s latest edition will feature an article on the off-label prescribing of the highly potent narcotic lollypop, an article noting that as much as 80% of scripts for Actiq are for off-label use.
Sources indicate this was brought to the reporter’s attention by an unusual source – the risk management department of The Washington Post, Newsweek’s sister publication, noticed a high incidence of Actiq scripts among its workers comp patients, and started digging into the issue.
May
2
Pharmacy chains demand higher payment for workers comp scripts. WC takes more work, as the pharm tech has to determine eligibility and do more work to get a script processed. Therefore, it’s logical that the chains charge more for WC.
Except that isn’t what’s happening.