Category: Workers Comp

May
22

You need a P&T Committee

Posted by Joe Paduda on Tuesday, May 22nd, 2007 | Comments

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.

Continue reading You need a P&T Committee

May
16

Rats fleeing Tommy Noe

Posted by Joe Paduda on Wednesday, May 16th, 2007 | Comments

In a lesson for all those tempted to leverage their positions in the workers comp industry for ill purpose, I once again give you Tom Noe The latest? Rats as big as cats are scampering to safety, afraid they’ll be infected by his unsavory kind. (that’s not exactly what the article says, but as it does not indicate a direction of travel, and rats are great survivors, I made a guess…)
For humans, it’s better news. Convicted money launderer and swindler Noe is safely ensconced in solitary confinement in a Federal jail in Atlanta, where he is awaitnig transfer to another prison in Florida.

May
4

UPDATE – The lollypop story gets big

Posted by Joe Paduda on Friday, May 4th, 2007 | Comments

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.

Continue reading UPDATE – The lollypop story gets big

May
2

Group rates, comp claims

Posted by Joe Paduda on Wednesday, May 2nd, 2007 | Comments

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.

Continue reading Group rates, comp claims

May
2

What’s not at RIMS

Posted by Joe Paduda on Wednesday, May 2nd, 2007 | Comments

Dozens of brand spanking new workers comp pharmacy benefit managers (PBMs). Last year at RIMS every aisle was packed with shiny new booths staffed by folks who, as swiftly became painfully obvious, were rather new to WC.
Either they didn’t want to come to New Orleans (they are definitely missing out) or they are out of business, or out of the comp business. Most likely they found their group health contracts, systems and processes, and cost management techniques just didn’t work in the highly-regulated, state-specific, first-dollar-every-dollar world of WC.
We’ll miss their enthusaism and humor-generating ability (“and how many members do you have? what kind of tiered copays are you using? let me tell you about our unique formulary that controls costs!”) and trinkets.
Sort of.

Apr
26

Implants

Posted by Joe Paduda on Thursday, April 26th, 2007 | Comments

Just to be clear, I’m talking about the ones used in spine surgery, bone and joint surgery, and other orthopedic procedures. The use of surgical implants has grown dramatically, as have their prices, and the impact of utilization and price means big bucks for WC payers.
Big bucks as in $72 million in California alone. As in adding 11% to 33% to inpatient hospital bills in the Golden State.

Continue reading Implants