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State of the States June 23, 2023

topicals meds

Use of migraine medication among workers’ compensation prescriptions grew significantly in 2022

NationalEnlyte released its drug report on in & out of network trends for 2022. Topicals were labeled as the costliest drug class in workers’ compensation. Meanwhile, scripts per claim increased by 1.2 percent, cost per script rose by a mere 0.5 percent, and costs per claim plunged by 0.7 percent. The most utilized therapeutic classes were topicals, followed by opioids, anticonvulsants, NSAID's and muscle relaxants. Top 10 therapeutic classes accounted for 75.5 percent of total scripts and 76.9 percent of total costs. Significant utilization increases came from migraine medications at 14.8 percent, while opioids experienced the largest decrease at 7.7 percent.   

   Members of the state’s Industrial Commission (ICA) voice their concerns with surgery billing practices 


  •  Governor Katie Hobbs signed SB1164 into law this week. The legislation will create a designated fraud unit within the state’s Industrial Commission (ICA). Although the fraud unit's primary aim is to investigate fraudulent activities within the workers’ compensation system, it will also review unfair claim processing practices and bad faith actions from employers or carriers. Members from both sides of the aisle voiced their support for SB1164.  
  • ICA officials announced their concern with medical providers “coercing carriers, self-insured employers and claims representatives into agreeing to pay a certain percentage of billed charges for a surgery.” Officials from the ICA’s legal division say that this billing tactic is being used the day before or on the day of a scheduled surgery and “the implication is that the surgery would be delayed or canceled if the paper (form) is not signed.” The Commission says the practice also interferes with the statutory right of payers. 

Personnel from the state Board of Pharmacy held a hearing this week regarding drug delivery protocols

injured-workers-pharmacy-blog-delawareThe state’s Board of Pharmacy (BOP) is considering new rules regarding the delivery of drugs to a patient’s residence. Added subsection would prohibit the delivery of drugs to a patient’s residence where such drugs are intended to be later transported to another location for administration, and that require specialized storage, reconstitution, or compounding. Patients with bleeding disorders are exempted from this requirement. BOP officials also introduced subsection, which bars the delivery of a patient-specific compounded preparation to a practitioner’s office or infusion center unless there is a written agreement between the dispensing pharmacist and the ordering physician/facility. Written comments on these proposals are due by July 6th. Board personnel held a hearing on Wednesday to discuss the potential rule changes.  

The state legislature tweaked workers’ compensation statute language concerning medical reimbursement rates  

injured-workers-pharmacy-blog-maineSP 728 agreed upon in the state’s special session, seeks to clarify independent contractor status, premium adjustments and address reimbursement rates if the medical fee schedule is not established or updated in workers’ compensation. The bill approved by the Governor yesterday removes language that dictates if the workers’ compensation board fails to adopt medical fee schedule the reimbursement rate for medical services would be "105 percent of the private 3rd party payor average payment for the provider." New language would replace the deleted provision with the "amount established by the medical fee schedule in effect on the date the update is due.”  

Statehouse leaders approved legislation that would alter the procedure for second medical opinions in workers’ compensation

injured-workers-pharmacy-blog-minnesotaHF2988, proposed by the state’s Workers’ Compensation Advisory Council, received approval from the state legislature last week. The bill contains multiple measures that would affect the state’s workers’ compensation program. Bill language includes protocols for medical second opinions, fees for medical records, clarification on a hospital’s usual & customary charges, and a planned reduction in overall hospital outpatient fee schedule reimbursements over the next three years. Provisions within the bill contain varying effective dates. 

State regulators are proposing new rules aiming to enhance prescription drug delivery processes

injured-workers-pharmacy-blog-texasOfficials from the state Board of Pharmacy issued newly proposed rules concerning the delivery of prescription drugs. The added provisions would require all classes of pharmacies to "ensure the integrity of any prescription drug requiring temperature control other than "room temperature" storage that is delivered by mail” The board is mandating that pharmacy’s utilize “temperature tags, time temperature strips, insulated packaging, gel ice packs, or a combination of these as necessary." Language within the proposal also clarifies that "prescription drugs are (to be) packaged in tamper proof and tamper evident mailers that are resistant to tearing and moisture." Comments on these regulatory proposals will be accepted until 5PM CST on July 24th. The earliest date of adoption for the rule is anticipated for July 16th.  


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