CompPharma Fights Attempt To Eliminate Pharmacy Savings In Workers’ Comp

Tampa, FL (WorkersCompensation.com) - Legislation currently being considered in the New York Senate and Assembly (S.3749 and A.5183) will increase employers' costs, eliminating the pharmacy savings from 2007's workers' compensation reforms, according to Joseph Paduda, president of CompPharma, an organization of workers' compensation pharmacy benefit managers (PBMs). 

Since the reforms, PBMs have been working with payers and pharmacies to ensure patient access to medications while also reducing the price of prescriptions. According to the Workers' Compensation Research Institute's Dec. 2011 Research Bulletin, reforms decreased the average price per pill between 10 and 20 percent. 

Routing a prescription through a PBM and its pharmacy network increases patient safety, alerting the pharmacist and payer to potentially harmful medication issues, such as drug-to-drug interactions, narcotic overuse/abuse and potential prescription fraud or diversion.  Prescriptions filled outside pharmacy networks and PBMs do not undergo these safeguards.

“Clinical safeguards are particularly important in light of the increasing level of opioid abuse in workers' compensation.  These bills would eradicate a key element of patient safety and pharmacy savings, essentially imposing a cost increase on all New York employers,” Paduda said, noting that workers' compensation payers include cities, counties and school boards as well as self-insured private and public companies and insurance carriers representing smaller employers. 

Proponents of S 3749 and A 5183 claim patient access to medication is a problem.  However, under existing NY-WCB rules injured employees are able to select from dozens of network pharmacies near their homes or workplaces. If no network pharmacy is located within one mile of the employee's residence in an urban area or within 10 miles in rural areas, they can choose any pharmacy. 

“Access has not been and is not a problem,” Paduda said. 

About CompPharma

Established by industry consultants Joseph Paduda and Helen Knight, CompPharma, LLC is a consortium of workers' compensation PBMs active in workers compensation. Member PBMs are Cypress Care, Express Scripts, Healthesystems, Modern Medical, Inc., MyMatrixx, PMSI, Progressive Medical Inc., ScripNet, and SXC Health Solutions.

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