physician dispensing in work comp
DESCRIPTION
Physician Dispensing in Work Comp. Impact of the practice on overall costs and exposure Tips on how to manage it. Pharmacy drives 10-20% of your unit cost as a percent of total medical. What percent of your total exposure relates to claims with prescription meds and IWs suffering from pain?. - PowerPoint PPT PresentationTRANSCRIPT
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Physician Dispensing in Work CompImpact of the practice on overall costs and exposureTips on how to manage it
©2014 CorVel Corporation. All rights reserved.
Hospital and Facility
Physician ServicesPharmacy
Physical Medicine
Imaging DMEPharmacy drives 10-20% of your unit cost as a percent of total
medical.
Source: 2011 NCCI Issues Report
What percent of your total exposure relates
to claims with prescription meds and
IWs suffering from pain?
©2014 CorVel Corporation. All rights reserved.
Physician Dispensing Price Difference: TramadolTramadol
50 MG
Manufacturer/ Labeler
AWP Price per Pill
AWP Price - 60 Pills
Package Size Dispensed Mark-up*
00093-0058-05 Teva USA $ .83 $ 49.80 500 60 0%
65162-0627-50 Amneal $ .83 $ 49.80 500 60 0%
36329-2868-02 Bryant Ranch $1.61 $ 96.60 60 60 194%
33261-0105-60 Aidarex Pharm $1.62 $ 97.20 60 60 195%
42549-0527-60 Stat Rx USA $1.66 $ 99.60 60 60 200%
55045-2928-09 DRX $1.55 $ 93.00 60 60 187%
60760-0377-60 St. Mary’s $1.41 $ 84.60 60 60 170%
66336-0915-60 Dispensing Solutions $1.55 $ 93.00 60 60 187%
* Percent of mark-up measured against original manufacturers’ AWP.
©2014 CorVel Corporation. All rights reserved.
Release of Study Medical Costs
Indemnity Costs
Source
CA Feb 2013 +17% +13% http://www.cwci.org/press_release.html?id=318
IL May 2014 +39% +27% (JOEM _ Volume 56, Number 5, May 2014 Physician-Dispensed Medication and Workers’ Compensation Claim Outcomes)
IL May 2014 opioids
+78% +57% (JOEM _ Volume 56, Number 5, May 2014 Physician-Dispensed Medication and Workers’ Compensation Claim Outcomes)
What the studies say:Impact of Physician Dispensing on Total Claim Costs
©2014 CorVel Corporation. All rights reserved.
Questions for the Audience
• Where do we see “third party billing?” Retail, Physician Dispensing, Everywhere!
Stone River (retail and physicians), Prescription Partners
©2014 CorVel Corporation. All rights reserved.
Questions for the Audience• Where do we see “third party
• Partners• What is the legal status of the third party biller?
Assignee• What are the obligations of an assignee?
Identical to the underlying provider
©2014 CorVel Corporation. All rights reserved.
Questions for the Audience• Where do we see “third party
• eywhertail and p• What are the obligations of an assignee?
Identical to the underlying provider
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The FactsAssignees are ALREADY OBLIGATED!
• PBM Contracts with underlying pharmacies• PPO Contracts with underlying prescribers
©2014 CorVel Corporation. All rights reserved.
The Facts
Assignees are ALREADY OBLIGATED!• PBM Contracts with underlying pharmacies• PPO Contracts with underlying prescribers
Impact of contracts with assigneesGrant them rights and frees them from obligations Disables Prospective Mgt/ Enables more retro PBM re-sells transaction at a spreadExpedient? Right thing to do?
©2014 CorVel Corporation. All rights reserved.
What you can do
Apply underlying PPO discount• Can I?• Everywhere?• Yes you can!
Deny subsequent transactions based on PPO contractual obligations
• Can I?• Everywhere?• PPO - Utilization Mgt or specific prohibition• Contractually yes, but leverage is the issue• Requires notice• Re
©2014 CorVel Corporation. All rights reserved.
Question for the Audience
What presents more risk in terms of your cost drivers?
• Unit price?• Utilization?
• The unknown?
©2014 CorVel Corporation. All rights reserved.
Identify providers who dispense meds in office
• Leverage bill review • Manage the data
Maximize provider selection tools• Include a physician dispensing indicator • Layer the order based on criteria• Preclude panel populating • Educate your PPO providers• Re
You can make the unknown more known!
©2014 CorVel Corporation. All rights reserved.
Search Results – Make them meaningful
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Appendix
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Agenda
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Agenda