CompPharma Survey Reveals Payer Concern Over PBM Transparency in Pricing
MAGGIE VALLEY, N.C.--(BUSINESS WIRE)--Nov 12, 2019--
CompPharma’s 16 th Annual Survey of Prescription Drug Management in Workers’ Compensation points to a keen interest in transparency in pharmacy pricing. Additionally, opioid prescriptions declined along with overall pharmacy spend.
“Eighty-three percent of the respondents considered the lack of transparency in pricing to be the number-one problem in work comp pharmacy,” said CompPharma President Joe Paduda, who has conducted the survey for 16 consecutive years. “However, their definitions of transparency and knowing what they would do with ‘transparent’ data are not clear.”
Some suggested separating drug costs from value-added services, such as clinical management, yet several knowledgeable professionals identified considerable administrative and operational challenges with that model.
Respondents were decision makers, clinical personnel, and operations staff from a broad spectrum of workers’ compensation insurance carriers, third-party administrators, self-insured employers, and state funds. These organizations’ annual drug spend ranged from $400,000 to more than $200 million.
Their combined data showed that overall drug spending decreased by 10.1% between 2017 and 2018. “Payers attributed the decline to renegotiated contracts with their pharmacy benefit managers (PBMs) or contracting with a new PBM along with the ongoing impacts of the California work comp fee schedule,” Paduda noted.
Opioid spend dipped 19 percent, with 56 percent of respondents saying they made more progress curbing the initial use of opioids than reducing long-term opioid use. Most respondents felt that pharmacy spend is fairly well controlled but stressed the need for vigilance because experience tells them that some new cost driver is right around the corner.
The report noted that PBMs have been instrumental in reducing unnecessary drug costs, and as a result, the current PBM model is not sustainable. As drug spend decreases, PBMs have fewer dollars to invest in clinical management, analytics and patient outreach.
A complimentary copy of CompPharma’s 16 th Annual Survey of Prescription Drug Management in Workers’ Compensation can be downloaded from www.comppharma.com/resources.
Owned by Joseph Paduda and Helen King Patterson, CompPharma, LLC is a research and consulting firm focused on pharmacy management in workers’ compensation. More information is available at www.comppharma.com or by contacting Patterson at 813-690-4787 or email@example.com.
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Helen King Patterson, 813-690-4787;firstname.lastname@example.org
KEYWORD: NORTH CAROLINA UNITED STATES NORTH AMERICA
INDUSTRY KEYWORD: INSURANCE PHARMACEUTICAL NURSING HUMAN RESOURCES MANAGED CARE FINANCE HEALTH PROFESSIONAL SERVICES
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