Workers Compensation Matters
|
|
- Curtis Baker
- 8 years ago
- Views:
Transcription
1 Workers Compensation Matters Fall 2012 In This Issue 2012 Conferences pg. 2 Ongoing OASIS Enhancements pg. 2 Compliance Update pg. 3 Innovative Injured Workers Pilot Shows Great Success pg. 5 Team Spotlight: Tim Pokorney pg. 6 FDA Approves Long-Acting Opioid REMS Program On July 9, the U.S. Food and Drug Administration (FDA) approved the long-awaited Risk Evaluation and Mitigation Strategies (REMS) program designed for long-acting opioid narcotics. REMS policies are mandatory programs to provide education about and safety awareness of certain classes of high-risk medications. The program was initiated as part of the 2011 Prescription Drug Abuse Prevention Program, designed by the White House Office of National Drug Control Policy. The program mandates that manufacturers of select long-acting narcotics must offer continuing education programs to help prescribers weigh the medications risks and benefits, and identify misuse, addiction and abuse. The courses must be reviewed and approved by a third party to guard against commercial bias and ensure that mandatory components are covered. Currently, prescriber participation is voluntary; however, some groups would like to see the education required in order to prescribe longacting opioids. Manufacturers are required to educate patients on how to safely take, store and dispose of these medications. They provide handouts containing this information to pharmacies for distribution with each prescription. The following medications are now part of the REMS Long-Acting Opioid Program: Avinza Butrans Dolophine Duragesic Embeda Exalgo Kadian MS Contin Opana ER Oramorph OxyContin
2 2012 Conferences September Western Occupational Health Conference: Sept , San Francisco CA Workers Compensation Risk Conference: Sept , Dana Point, Calif. October Wisconsin WC Forum: Oct , Pewaukee, Wisc. Tropics Conference: Oct , Lido Key, Fla. November National WC/Disability Expo: Nov. 6-8, Las Vegas, Nevada Ongoing OASIS Enhancements Express Scripts understands the day-to-day challenges of managing claims and strives to develop opportunities to improve efficiency with enhancements to OASIS, our prior authorization tool. We are excited to announce that OASIS is about to become even more efficient and easier to use. We want to ensure that people handling claims have the tools they need to respond in a timely fashion so that injured workers receive their medication as quickly as possible, says Hollie Bowyer, director, Product Management for Workers Compensation. Many of the OASIS enhancements we re making today stem from client feedback, as well as the anticipation of their future needs. Express Scripts is creating new solutions to help clients better manage their pharmacy claims in the mobile environment as well. The enhancements are scheduled to be released later this fall and include: authorization at different drug levels improved efficiency for navigating through My Queue additional data on the Medication tab view and edit a previously-addressed prior authorization the ability to prevent authorization from escalating 2
3 Compliance Updates California: Electronic and Standardized Billing Regulations The California Division of Workers Compensation (DWC) adopted regulations to standardize paper medical treatment billing forms and electronic medical billing standards. Provisions relating to paper billing became effective Oct. 15, 2011; electronic billing provisions become effective Oct. 18, Updated Pharmaceutical Price Files Posted Between Fall 2011 and Spring 2012, the DWC was unable to post updated pharmaceutical fees to their website due to a delay in the availability of Medi-Cal pharmaceutical price data. The Department of Health Care Services indicated that, beginning May 2012, the weekly pharmaceutical fee data file sent to the California DWC includes all national drug code (NDC) price updates that were missing due to the temporary unavailability of average wholesale prices (AWP) from First Data Bank between Sept. 1, 2011 and March 14, Proposed State Reporting Penalty Language The DWC drafted regulations providing administrative penalties for Workers Compensation Information System (WCIS) reporting violations. In October 2011, Senate Bill 826 was signed into law, amending sections and of the California Labor Code. The bill authorizes the California DWC to assess administrative penalties for claims administrators failure to comply with WCIS reporting requirements. sb_ /sb_826_bill_ _chaptered.pdf Colorado: Proposed changes to Medical Fee Schedule and Treatment Guidelines The Colorado DWC drafted amendments to the Workers Compensation Rules of Procedure. WorkComp/CDLE/ Connecticut: Adopts Repackaged Drug Language The Connecticut Workers Compensation Commission has decided to limit the price of repackaged drugs as part of the state s medical fee schedule, effective July 15, Louisiana: Adopts Pharmacy Electronic Billing Standards The Louisiana Workforce Commission, Office of Workers Compensation adopted legislation to establish electronic billing standards under LAC 40:I.Chapter 3. Maryland: Withdraws Proposed Pharmaceutical Fee Schedule The Maryland Workers Compensation Commission decided to remove the proposal to amend Regulations.01 and.04, and new Regulation.09 under COMAR Guide of Medical and Surgical Fees. Michigan: Proposed Repackaged Drug Language The Michigan Department of Licensing and Regulatory Affairs, Workers Compensation Agency proposed changes to its Health Care Services Rules. ORR/1005_ LR_orr-draft.pdf Disclaimer: The information contained herein is general in nature and should not be construed as legal advice to be applied to any specific factual situation. As the law differs in each jurisdiction and may be interpreted or applied differently depending on your location or situation, you should consult a lawyer if you have any questions. Express Scripts is not providing legal advice. 3 Continued on next page
4 Compliance Update Continued New York: Emergency Regulations continue to be re-adopted, with most recent Emergency Regulation effective June 11, 2012 through Sept. 10, 2012 The Workers Compensation Board continues to re-adopt the Subchapter M emergency regulations created to address pharmacy and durable medical goods. The latest version is effective June 11, 2012 through Sept. 10, Emergency/SubchapterM_ jsp North Carolina: Proposal to establish Electronic Billing Rules The North Carolina Industrial Commission proposed to implement electronic medical billing provisions for workers compensation. Electronic%20Billing%20-%20OAH.pdf Tennessee: Adopts changes to Pharmacy Fee Schedule Guidelines The Tennessee Department of Labor and Workforce Development, Division of Workers Compensation adopted changes to its Pharmacy Schedule Guidelines ( ), effective June 10, Texas: Adopts changes to Pharmacy Fee Schedule Guidelines The Texas Department of Insurance (TDI), DWC adopted rules to amend 28 TAC (General Rules for Medical Billing and Processing), , , (Medical Bill Processing/Audit by Insurance Carrier), (Dispute of Medical Bills) and (Prospective and Concurrent Review of Health Care), effective July 1, documents/ao m.pdf Disclaimer: The information contained herein is general in nature and should not be construed as legal advice to be applied to any specific factual situation. As the law differs in each jurisdiction and may be interpreted or applied differently depending on your location or situation, you should consult a lawyer if you have any questions. Express Scripts is not providing legal advice. 4
5 Innovative Injured Worker Pilot Shows Great Success Express Scripts works with clients to provide a pharmacy program focused on safety, while managing drug spend by converting brand-name drugs to generics whenever clinically appropriate. Traditionally, interventions such as the Physician Outreach Program (POP) letters to physicians, genericmandate edits viewed by pharmacists at the point of service, or step therapy are successful in increasing our clients generic fill rates (GFR). However, because injured workers are not required to pay for their medications, there is no financial incentive to move to generics. Conventional wisdom has been that communicating with the injured worker about switching to generics was fruitless. That is, until now. In February 2012, Express Scripts ran a randomized control trial to test whether or not a letter to injured workers would increase generic conversions, despite a lack of any financial benefit to the worker by doing so. Using tested Consumerology principles, Express Scripts crafted new letters to injured workers testing two differing messages against a control group that did not receive any direct communication: An authority message from a physician to an injured worker, emphasized the safety of generics and noted that the physician recommends generics for his own family. A social responsibility message tested the theory that injured workers would be willing to convert to generics to help control the rising cost of prescription drugs, even if they receive no direct monetary benefit from doing so. Both letters urged the injured workers to consult with their physician regarding their treatment. Both proved successful; however, the social responsibility letter was the statistically-significant winner. Injured workers who received it were 59.5% more likely to convert to a generic drug than those that did not receive a letter. The results of this study have provided tremendous insight and could potentially offer a new strategy for everyone involved in the management of a workers compensation claim. Express Scripts will continue to empower injured workers to make the best decisions regarding their medications. With this in mind, Express Scripts is building new communication programs to better engage injured workers in their own treatment. Included in this strategy is the expansion of this pilot into a full product, featuring the winning letter as its cornerstone. Express Scripts is committed to leveraging all of its assets clinical, safety and trend management programs and the work of the Research and New Solutions Lab to improve the safe and effective treatment of injured workers, while reducing drug spend for workers compensation clients. 5
6 Team Spotlight: Tim Pokorney, RPh, Clinical Director Tim Pokorney brings his background as a clinical pharmacist and his experience in workers compensation to his role as Clinical Director. In this position, Tim leads our team of clinical pharmacists dedicated to achieving and maintaining strong clinical results for our clients. Tim and his team provide extensive consultation to clients and analyze drug utilization trends for the Workers Compensation market. Tim oversees our suite of comprehensive clinical programs, including initiatives to address the abuse and/or misuse of narcotics. Now, more than ever, it is important for payers to aggressively manage cost and utilization, says Tim. My team and I are dedicated to helping clients minimize the risks of narcotic abuse and misuse. Our new solutions are already significantly contributing to the safety of injured workers, while curbing the rising costs for payers. Tim has worked for Express Scripts for seven years and in Workers Compensation for 5 of those years. During his tenure, his roles have afforded him experience in client contracting, account management, pharmacy operations and clinical services. He has led several speaking engagements for clients and the workers compensation marketplace. Tim earned his pharmacy degree from the St. Louis College of Pharmacy Express Scripts Holding Company. All Rights Reserved Let Express Scripts help you maximize your workers compensation pharmacy program. Call us at or us at max@express-scripts.com.
Opioids and the Injured Worker Tools for Successful Outcomes
Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,
More informationReducing Narcotics Misuse and Abuse in Workers Compensation
Reducing Narcotics Misuse and Abuse in Workers Compensation Trusted. Reliable. Sustainable. Page 2 Introduction Narcotics have a long history of being used to therapeutically treat pain resulting from
More informationSENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015-2016 Regular KEY ISSUE ANALYSIS
SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015-2016 Regular Bill No: AB 1124 Hearing Date: July 13, 2015 Author: Perea Version: June 1, 2015 Urgency: No Fiscal: Yes
More informationColorado Prescription Drug Monitoring Program. Department of Regulatory Agencies Division of Professions and Occupations State Board of Pharmacy
Colorado Prescription Drug Monitoring Program Department of Regulatory Agencies Division of Professions and Occupations State Board of Pharmacy DORA is dedicated to preserving the integrity of the marketplace
More informationTHE QUESTION OF THE HOUR
WORKERS COMPENSATION THE QUESTION OF THE HOUR Of the emerging trends for Workers Compensation in 2009, several will help answer what for many is the main question of the moment: How have the economy and
More informationCompPharma. Manage. Process. Inform. Ensure. The Role of a PBM in Workers Compensation
Manage Inform Process Ensure The Role of a PBM in Workers Compensation Understanding the role of workers compensation pharmacy benefit managers (WC-PBMs) can help state and local government agencies ensure
More informationSUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.10. 1. INTRODUCTION. The Commissioner of Workers Compensation
Part 2. Texas Department of Insurance, Page 1 of 10 SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.10 1. INTRODUCTION. The Commissioner of Workers Compensation ( Commissioner ), Texas
More informationTARGETING PRESCRIPTION DRUGS TO DECREASE WORKERS COMPENSATION COSTS
MARSH RISK MANAGEMENT RESEARCH TARGETING PRESCRIPTION DRUGS TO DECREASE WORKERS COMPENSATION COSTS MARCH 2015 Attacking medical costs can be one of the most effective ways to rein in the high price of
More informationState Advocacy Guide to Prescription Drug Monitoring Program Legislation and Regulations
State Advocacy Guide to Prescription Drug Monitoring Program Legislation and Regulations There is currently an epidemic of prescription opioid abuse, misuse and diversion in the U.S. Numerous federal,
More informationOpioid Prescribing Practices and Pain Management: Role of FDA Douglas C. Throckmorton, MD Deputy Director for Regulator Programs, CDER, FDA
Opioid Prescribing Practices and Pain Management: Role of FDA Douglas C. Throckmorton, MD Deputy Director for Regulator Programs, CDER, FDA American Academy of Hospice and Palliative Care Medicine October,
More informationBlueprint for Prescriber Continuing Education Program
CDER Final 10/25/11 Blueprint for Prescriber Continuing Education Program I. Introduction: Why Prescriber Education is Important Health care professionals who prescribe extended-release (ER) and long-acting
More informationDecember 2, 2013. The Honorable Marguerite Quinn The Pennsylvania General Assembly 159A East Wing PO Box 202143 Harrisburg, PA 17120-2143
December 2, 2013 The Honorable Marguerite Quinn The Pennsylvania General Assembly 159A East Wing PO Box 202143 Harrisburg, PA 171202143 Dear Representative Quinn, On behalf of PMSI and the national trade
More informationTHE EXAMINER. Quarterly review of legislative and regulatory updates impacting the workers compensation and auto casualty markets.
NOVEMBER 2013 THE EXAMINER IN THIS ISSUE Featured State Legislative Updates Illinois WC Regulation - Workers Compensation Preferred Provider Program...1 Texas House Bill 1322 DME & Home Health Care Reimbursement...1
More information2015 ANNUAL REVIEW OF PRESCRIPTION MONITORING PROGRAMS
2015 ANNUAL REVIEW OF PRESCRIPTION MONITORING PROGRAMS Research current through September 2015. This project was supported by Grant No. G1599ONDCP03A, awarded by the Office of National Drug Control Policy.
More informationFDA Advisory Committee Hearing on Potential Rescheduling of Hydrocodone: Pharmacist and Pharmacy Issues to Consider
FDA Advisory Committee Hearing on Potential Rescheduling of Hydrocodone: Pharmacist and Pharmacy Issues to Consider January 24, 2013 FDA White Oak Campus Steve Simenson, BPharm, FAPhA, DPNAP APhA President
More informationPrescribers required to check PDMP before first prescription for Controled Substances for new patient.
State, District, or Territory Alabama Arizona Arkansas Colorado Connecticut Delaware Georgia Guam Criteria for Mandatory Enrollment or Query of PDMP Before renewing an Alabama Controlled Substances Certificate,
More informationSUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY 28 TAC 19.1701 19.
Part I. Texas Department of Insurance Page 1 of 244 SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY 28 TAC 19.1701 19.1719 SUBCHAPTER U.
More informationImpact Of A Texas-Like Formulary In Other States
Impact Of A Texas-Like Formulary In Other States May 2016 1 About WCRI Independent, not-for-profit research organization Diverse membership support Studies are peer-reviewed Resource for public officials
More informationFocus on Pharmacy Management PHYSICIAN DISPENSING
PHYSICIAN DISPENSING 1 Introduction The National Council on Compensation Insurance (NCCI), the largest provider of workers compensation and employee injury data and statistics in the nation, released a
More informationEvaluating the impact of REMS on burden and patient access
Evaluating the impact of REMS on burden and patient access Doris Auth, Pharm.D. Team Leader, Division of Risk Management Office of Medication Error Prevention and Risk Management Center for Drug Evaluation
More informationWhat Role Does an Effective Drug Testing Program Play in Workers Compensation?
What Role Does an Effective Drug Testing Program Play in Workers Compensation? William J. Judge, JD, LLM Research Counsel to Park-Dickens Group, LLC And the FightReady Service 708-334-8010 bjudge@fightreadynow.com
More informationState Policies Affecting the Cost and Use of Pharmaceuticals in Workers Compensation: A National Inventory
State Policies Affecting the Cost and Use of Pharmaceuticals in Workers Compensation: A National Inventory Richard A. Victor Petia Petrova Workers Compensation Research Institute With the assistance of:
More informationFor a Healthier America: Reducing Prescription Drug Misuse and Abuse
For a Healthier America: Reducing Prescription Drug Misuse and Abuse The misuse and abuse of prescription medicines is a growing public health problem. In addition to the tragic toll on families and communities,
More informationThe Excelsior Solutions Difference
The Excelsior Solutions Difference Expert pharmacy benefit management (PBM) consulting team In-house pharmacists, PBM and Medicare Part D experts Former C-level PBM executives averaging 20+ years industry
More informationFREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS OFFICAL MEDICAL FEE SCHEDULE (OMFS), INPATIENT HOSPITAL FEE SCHEDULE (IHFS) AND MEDICAL-LEGAL FEE SCHEDULE (MLFS) How do I get an Official Medical Fee Schedule book and how much
More informationPractical Implementation of Risk Evaluation And Mitigation Strategies in Health Systems: The Experts Answer Your Questions
Practical Implementation of Risk Evaluation And Mitigation Strategies in Health Systems: The Experts Answer Your Questions Faculty James M. Hoffman, Pharm.D., M.S., BCPS Medication Outcomes and Safety
More informationThe Vermont Legislative Research Shop
The Vermont Legislative Research Shop Drug-Free Workplace Laws The Constitutionality of Drug Testing in the Workplace Court opinions on drug testing in the workplace have been based primarily upon the
More informationPART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION SERVICE TITLE 4. AGRICULTURE TITLE 28. INSURANCE
TITLE 4. AGRICULTURE PART 12. SERVICE TEXAS A&M FOREST CHAPTER 215. FOREST ZONE DETERMINATION PROCEDURE 4 TAC 215.1, 215.5, 215.9, 215.13, 215.17, 215.21, 215.35 Texas A&M Forest Service (Agency) adopts
More informationSTATE PLAN TO PREVENT AND TREAT PRESCRIPTION DRUG ABUSE RECOMMENDATION SUMMARY Governor s Prescription Drug Abuse Prevention Council
STATE PLAN TO PREVENT AND TREAT PRESCRIPTION DRUG ABUSE RECOMMENDATION SUMMARY Governor s Prescription Drug Abuse Prevention Council PRIORITY AREA: PRESCRIBERS Recommendation: The Council recommends that
More informationPharmacy Law Overview. From Civil Liability to Criminal Prosecution
Pharmacy Law Overview From Civil Liability to Criminal Prosecution Law That Matters To Pharmacists Robert P. Esgro, R.Ph., Esq. Pharmacy Lawyer and Consultant 610-308-6666 Bob@PharmacyLawyer.com Pharmacy
More informationPrescription Drug Monitoring Program Center of Excellence at Brandeis
Prescription Drug Monitoring Program Center of Excellence at Brandeis Notes from the Field NF 4.1 Using PDMPs to Improve Medical Care: Washington State s Data Sharing Initiative with Medicaid and Workers
More informationProtecting your employees, physicians and you.
Protecting your employees, physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution - now with real outcomes. Opioids are the most common drugs prescribed in workers
More informationRoadmap. Florida Trends in Prescription Drug Abuse. Oath of a Pharmacist. Plantation Chemist Busted
Florida Trends in Prescription Drug Abuse Jennifer A. Fass, PharmD, CPh Clinical Assistant Professor fass@nova.edu Roadmap Discuss Florida Medical Examiners Report Illustrate prescription drug abuse cases
More informationSTATE OF TENNESSEE. Workers Compensation Advisory Council. REPORTS TO THE GENERAL ASSEMBLY and THE SPECIAL JOINT COMMITTEE ON WORKERS COMPENSATION
STATE OF TENNESSEE Workers Compensation Advisory Council ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ REPORTS TO THE GENERAL ASSEMBLY and THE SPECIAL JOINT COMMITTEE ON WORKERS COMPENSATION Findings and
More informationPharmaceutical Marketing & Economic issues: Drug copay subsidies ( coupons ) and potential consumer and State interests
Pharmaceutical Marketing & Economic issues: Drug copay subsidies ( coupons ) and potential consumer and State interests Wells G. Wilkinson Staff Attorney, Community Catalyst Director, Prescription Access
More informationACTION ITEM COMPLETED TAB 44
H.B. 1 H.B. 751 Provisions of the H.B. 1 Appropriations Act The base appropriation for TSBP for FY2016-2017 is approximately $234,000 more than the base appropriation the previous biennium. The majority
More informationSpecialty Pharmacy? Disclosure. Objectives Technician
Disclosure What s so SPECIAL about? I have no actual or potential conflict of interest in relation to this program/presentation. Michael DeCoske, PharmD, BCPS Associate Chief Pharmacy Officer Duke University
More informationStrong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER
Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER November 17, 2015 Today s Speakers Karmen Hanson, Program Manager, NCSL Cynthia Reilly, Director,
More informationTitle 40. Labor and Employment. Part 1. Workers' Compensation Administration
Title 40 Labor and Employment Part 1. Workers' Compensation Administration Chapter 3. Electronic Billing 301. Purpose The purpose of this Rule is to provide a legal framework for electronic billing, processing,
More informationThe Questionable Employment Tax Practices Initiative Progress Report
The Questionable Employment Tax Practices Initiative Progress Report April, 2011 QETP Oversight Team Members Include: Internal Revenue Service U.S. Department of Labor National Association of State Workforce
More informationPA CME Requirements. Alaska Alaska Physician Assistants must maintain an active NCCPA certification for license renewal.
PA CME Requirements Alabama Alabama Physician Assistants must complete 25 hours of AMA PRA Category 1 or equivalent (AOA, AAFP, ACOG) CME every year for annual license renewal. If the licensee does not
More informationFalse Claims Laws: What Every Public Contract Manager Needs to Know By Aaron P. Silberman 1
False Claims Laws: What Every Public Contract Manager Needs to Know By Aaron P. Silberman 1 When Do False Claims Laws Apply? The federal False Claims Act (FCA) applies to any requests for payment from
More informationPrescription Monitoring Programs: Creating a National Network
Prescription Monitoring Programs: Creating a National Network Danna E. Droz, JD, RPH PMP Liaison ddroz@nabp.net 847/391-4508 United States Drug Enforcement Administration National Conference on Pharmaceutical
More informationROBERT SALCIDO CONFERENCE PRESENTATIONS
ROBERT SALCIDO CONFERENCE PRESENTATIONS Maryland, Topic: The Compliance Conundrum: What to Do When a Potential Whistleblower Appears in Your Office? (Sept. 30-Oct. 2, 2012). American Bar Association s
More informationTechnical Assistance Guide No. 04-13 Funding Options for Prescription Drug Monitoring Programs
Technical Assistance Guide No. 04-13 Funding Options for Prescription Drug Monitoring Programs July 3, 2013 Introduction Over the past ten years, prescription drug monitoring programs (PDMPs) have proliferated
More informationEconomic Impact and Variation in Costs to Provide Community Pharmacy Services
Economic Impact and Variation in Costs to Provide Community Pharmacy Services Todd Brown MHP, R.Ph. Associate Clinical Specialist and Vice Chair Department of Pharmacy Practice School of Pharmacy Northeastern
More informationFDA LACKS COMPREHENSIVE DATA TO DETERMINE WHETHER RISK EVALUATION AND MITIGATION STRATEGIES IMPROVE DRUG SAFETY
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL FDA LACKS COMPREHENSIVE DATA TO DETERMINE WHETHER RISK EVALUATION AND MITIGATION STRATEGIES IMPROVE DRUG SAFETY Daniel R. Levinson Inspector
More informationPrescription drug costs continue to rise at
Prescription Drugs Developing an Effective Generic Prescription Drug Program by John D. Jones Pharmacy benefit managers (PBMs) use a variety of pricing strategies. When employers have a thorough knowledge
More informationReport of the Executive Committee
Report of the Executive Committee NABP 109 th Annual Meeting May 18-21, 2013 St Louis, MO Presented by: Malcolm J. Broussard, RPh Good afternoon. It is a pleasure to see so many of you here in St Louis
More informationStates and HIPAA information
States and HIPAA information Prepared by: Jennifer Bible, MSW Alabama: Alabama s Medicaid website contains HIPAA information at http://www.medicaid.alabama.gov/resources/hipaa.aspx?tab=5. Extensive FAQ
More informationCancellation/Nonrenewal Surplus Lines Exemptions
Cancellation/Nonrenewal Surplus Lines Exemptions * Indicates updates in laws or regulations for the state Contact: Tina Crum, tina.crum@pciaa.net, 847-553-3804 Disclaimer: This document was prepared by
More informationCHAPTER 114. AN ACT establishing a Medicaid Accountable Care Organization Demonstration Project and supplementing Title 30 of the Revised Statutes.
CHAPTER 114 AN ACT establishing a Medicaid Accountable Care Organization Demonstration Project and supplementing Title 30 of the Revised Statutes. BE IT ENACTED by the Senate and General Assembly of the
More informationAMERICAN NATIONAL INSURANCE COMPANY CREDIT INSURANCE DIVISION P. O. BOX 696785 * SAN ANTONIO, TEXAS 78269-6785 800-899-6502
P. O. BOX 696785 * SAN ANTONIO, TEXAS 78269-6785 DISABILITY CLAIM FORM INSTRUCTIONS Enclosed is a claim form required in order to process disability payments on your loan. It is important that all questions
More informationUnemployment Insurance and Social Security Retirement Offsets
Unemployment Insurance and Social Security Retirement Offsets By National Employment Law Project December 2003 Introduction The policy of denying or reducing unemployment insurance benefits to Social Security
More informationAn Overview of Risk Evaluation and Mitigation Strategy (REMS): Elements Related to Medication Use and Dispensing
INDIANA PHARMACISTS ALLIANCE (IPA) CONTINUING PHARMACY EDUCATION (CPE) 2012 Article #9 An Overview of Risk Evaluation and Mitigation Strategy (REMS): Elements Related to Medication Use and Dispensing Authors:
More information(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES FECA LHWCA
(In effect as of January 1, 2004*) TABLE 5a. MEDICAL BENEFITS PROVIDED BY WORKERS' COMPENSATION STATUTES Full Medical Benefits** Alabama Indiana Nebraska South Carolina Alaska Iowa Nevada South Dakota
More informationDRAFT GUIDANCE. This guidance document is being distributed for comment purposes only.
Guidance for Industry Format and Content of Proposed Risk Evaluation and Mitigation Strategies (REMS), REMS Assessments, and Proposed REMS Modifications DRAFT GUIDANCE This guidance document is being distributed
More informationProtecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution.
TM Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution. Goals of Opioid Defense Manager TM Opioids are the most common drugs prescribed
More informationList of States with Mandated ENERGY STAR Purchasing Efforts
List of States with Mandated ENERGY STAR Purchasing Efforts ALABAMA: Executive Order 33, enacted May 2006, proclaims that all State departments and agencies shall employ the latest energy conservation
More informationSubchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501
Page 1 of 22 pages Subchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501 1. INTRODUCTION. The Commissioner of the Division of Workers' Compensation, Texas Department
More informationMedicaid Covered Outpatient Prescription Drug Reimbursement Information by State. Quarter Ending September 2015
Medicaid Covered Outpatient Prescription Drug Reimbursement Information by State Quarter Ending September 2015 340B=prices charged to covered entities under the Public Health Services Act, AAC=actual acquisition
More informationGovernor s Task Force on Mental Health and Substance Use. www.ncdhhs.gov/mhsu
Governor s Task Force on Mental Health and Substance Use www.ncdhhs.gov/mhsu Problem Statement 97 Painkiller prescriptions per 100 North Carolinians Number of deaths by drug overdose in North Carolina
More informationAN OVERVIEW OF ALASKA S WORKERS COMPENSATION SYSTEM
AN OVERVIEW OF ALASKA S WORKERS COMPENSATION SYSTEM INTRODUCTION This paper is intended to foster a discussion of the current status of the Alaska workers compensation system, and the benefits and costs
More informationFlorida MCA Client Newsletter Fall 2013
A semi-annual educational newsletter dedicated to our clients using the Florida Managed Care Arrangement. FL MCA COMPLIANCE HIGHLIGHTS SEMI-ANNUAL NETWORK REVIEW JUN 2013 & NOVEMBER - ACCESS & AVAILABILITY
More informationMarriage Equality Relationships in the States
Marriage Equality Relationships in the States January 7, 2015 The legal recognition of same-sex relationships has been a divisive issue across the United States, particularly during the past two decades.
More informationCompounding Pharmacy Accreditation
Compounding Pharmacy Accreditation The time has come to vigorously support excellence in compounding. One of the most constant criticisms of bio-identical hormone therapy is that there is no mandated standard
More informationCollaboration and innovation are top strategies used by states seeking to improve workers compensation programs
Lessons to learn: Collaboration and innovation are top strategies used by states seeking to improve workers compensation programs New York state efforts still mixed, but moving forward the of the industry
More information2.1 Staying Clear of the Law and Addiction: Nevada s Pre- Criminal Intervention Program
PMP Center of Excellence Notes from the Field 2.1 Staying Clear of the Law and Addiction: Nevada s Pre- Criminal Intervention Program January 2011 This project was supported by Grant No. 2006-DG-BX-K071
More informationHealth Care Reform. Frequently Asked Questions. June 2013
Health Care Reform Frequently Asked Questions June 2013 Frequently Asked Questions (FAQs) What is a health insurance marketplace or exchange? A marketplace, or exchange, is a website where you can shop
More informationCoding Systems. Understanding NDC and HCPCS. December 2014
Coding Systems Understanding NDC and HCPCS December 2014 White Paper Coding Systems Understanding NDC and HCPCS National Drug Code The National Drug Code (NDC) serves as a universal product identifier
More informationLICENSING COMMITTEE AD-HOC Committee on Pharmaceutical Benefit Managers (PBMs) Regulation. Meeting Summary
California State Board of Pharmacy STATE AND CONSUMER SERVICES AGENCY 400 R Street, Suite 4070, Sacramento, CA 95814-6237 DEPARTMENT OF CONSUMER AFFAIRS Phone (916) 445-5014 GRAY DAVIS, GOVERNOR Fax (916)
More informationPursuant to the authority vested in the Commissioner of Health by Article 33 of the
Electronic Prescriptions and Records for Hypodermic Needles and Hypodermic Syringes Effective date: 10/9/13 Pursuant to the authority vested in the Commissioner of Health by Article 33 of the Public Health
More informationCAPITOL research. Interstate Information Sharing: Prescription Drug Monitoring Programs
The Council of State governments CAPITOL research APRIL 00 Prescription Drug Monitoring Interstate Information Sharing: Prescription Drug Monitoring Programs The Council of State Governments Misuse of
More informationWHITE PAPER The Impact of Rising Generic Drug Prices on the U.S. Drug Supply Chain
WHITE PAPER The Impact of Rising Generic Drug Prices on the U.S. Drug Supply Chain Over the past two years, the pharmacy industry has seen unprecedented increases in the prices of generic drugs, causing
More informationLicensure of Substance Abuse Treatment Programs Required Amendments
Licensure of Substance Abuse Treatment Programs Required Amendments Public Health Council August 12, 2015 Jim Cremer, Deputy Director Erica Piedade, Director of Quality Assurance & Licensing, Overview
More informationAre Formularies a Viable Solution for Controlling Prescription Drug Utilization and Cost in California Workers Compensation?
A R E P O R T T O T H E I N D U S T R Y Are Formularies a Viable Solution for Controlling Prescription Drug Utilization and Cost in California Workers Compensation? by Alex Swedlow, MHSA Steve Hayes, MHSA
More informationThe Success Family of CE Companies Affordable CE Success CE Success Live CE FirstChoice CE
Annuity Continuing Education Requirements by State As of September 17, 2015 Care has been taken to provide accurate information in the subject matter provided within this document. This information is
More informationDoes Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation
Does Texas Need a Workers Compensation System? Bill Peacock Texas Public Policy Foundation Beginnings of Workers Compensation Liability and Litigation in the 19 th Century The problem of industrial accidents
More informationFraud, Waste and Abuse
Fraud, Waste and Abuse CT - Fraud Hotline submitted by Connecticut The Fraud Hotline at the Department of Social Services (DSS) is a proactive approach to handling complaints regarding fraud and abuse
More informationFebruary 19, 2016. RE: Gilead Report Responses. Dear Senators Wyden and Grassley:
February 19, 2016 The Honorable Ron Wyden The Honorable Chuck Grassley Committee on Finance United States Senate 219 Dirksen Senate Office Building Washington, DC 20510-6200 RE: Gilead Report Responses
More informationStatement of the American Pharmacists Association Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA Executive Vice President and CEO.
Statement of the American Pharmacists Association Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA Executive Vice President and CEO FDA Public Hearing on Using Innovative Technologies and Other Conditions
More informationEMPLOYEE BENEFITS BRIEFING
EMPLOYEE BENEFITS BRIEFING LEGISLATIVE UPDATE by Jennifer Lunski, Esq. November 2011 At Woodruff-Sawyer, we offer frequent updates on legislative changes that impact employee benefit plans. Employers should
More information2014, That Was The Year That Was Greg Baran, RPh, MA, FMPA Baran Consulting LLC
2014, That Was The Year That Was Greg Baran, RPh, MA, FMPA Baran Consulting LLC Objectives 1. Review the changes to the pharmacy practice act related to sterile compounding. 2. Understand the role of the
More informationSea Change in Workers Comp SB 863 Overview and Update
Sea Change in Workers Comp SB 863 Overview and Update May 14, 2015 Panelist: Destie Overpeck Administrative Director Division of Workers Compensation Rupali Das, M.D. Executive Medical Director Division
More informationGENERAL OVERVIEW OF STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION [45 CFR Part 160 and Subparts A and E of Part 164]
GENERAL OVERVIEW OF STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION [45 CFR Part 160 and Subparts A and E of Part 164] OCR HIPAA Privacy The following overview provides answers to
More information11/26/2012. Implementation of Florida s PDMP. Disclosure
Implementation of Florida s PDMP Rebecca R. Poston Program Manager December 1, 2012 Disclosure I have no vested interest in or affiliation with any corporate organizations offering financial support or
More informationWhen Public Payment Declines, Does Cost-Shifting Occur? Hospital and Physician Responses. November 13, 2002 Washington, DC
When Public Payment Declines, Does Cost-Shifting Occur? Hospital and Physician Responses November 13, 2002 Washington, DC These materials were commissioned by the Robert Wood Johnson Foundation for use
More informationHEALTHCARE REFORM SOLUTIONS. Designing a Pharmacy Benefit for the New Public Health Exchange Consumers
HEALTHCARE REFORM SOLUTIONS Designing a Pharmacy Benefit for the New Public Health Exchange Consumers FEBRUARY 2013 EXECUTIVE SUMMARY Designing a Pharmacy Benefit for the New Public Health Insurance Exchange
More informationMedicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant
Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Issue Summary The term dual eligible refers to the almost 7.5 milion low-income older individuals or younger persons with disabilities
More informationC C VV I. California Workers Compensation Institute 1111 Broadway Suite 2350, Oakland, CA 94607 Tel: (510) 251-9470 Fax: (510) 251-9485
C C VV I California Workers Compensation Institute 1111 Broadway Suite 2350, Oakland, CA 94607 Tel: (510) 251-9470 Fax: (510) 251-9485 CWCI Research Brief Differences in Outcomes for Injured Workers Receiving
More informationInternet Prescribing Summary
Internet Prescribing Summary, Minnesota,,, South Dakota and Wisconsin (July 2011) Advancements in medicine and technology have transformed the way health care is delivered to patients. However, laws governing
More informationWORKERS COMPENSATION. Claims Kit
WORKERS COMPENSATION Claims Kit Dear Customer, Thank you for choosing ProSight Specialty Insurance as your Workers Compensation Insurance carrier. We pride ourselves on providing excellent service and
More information2013-2014: Top Ten Trends and Emerging Issues in Workers Compensation
The following chart includes ten workers compensation topics that are surfacing nationwide: (1) Opt Out, (2) Eliminating liberal construction of interpretation of work comp act, (3) AMA impairment guides
More information2015 Employee. Outlook A year of continued evolution. National Employee Benefits Practice
2015 Employee Benefits Outlook A year of continued evolution National Employee Benefits Practice Introduction The 2015 employee benefits outlook provides insights from the practice leaders at Wells Fargo
More informationTexas Workers Compensation
Texas Workers Compensation Tips for Successful Medical Billing and Reimbursement Practices Presented by: Regina Schwartz Health Care Specialist Texas Dept of Insurance - Division of Workers Compensation
More information5.42.2 Designated Workers Compensation Facilities
5.42 Workers Compensation Policy (adopted May 12, 2014) The College provides Workers Compensation benefits for all College employees pursuant to the mandates of the Missouri Workers Compensation Law. Employees
More informationWhen the workers compensation system in New York was reformed in 2007, the system worked poorly for both employers and employees.
New York's workers' comp: High benefits, higher costs New York s workers' comp benefits have risen to enter the mainstream but they cannot explain why employers costs remain so high By Paul Jahn Executive
More informationSTRATEGIES FOR MANAGING WORKERS COMPENSATION EXPERIENCE MODIFICATION FACTORS
STRATEGIES FOR MANAGING WORKERS COMPENSATION EXPERIENCE MODIFICATION FACTORS Introduction The National Council on Compensation Insurance (NCCI) recently announced its plan to modify how a company s Experience
More informationP.L.2015, CHAPTER 179, approved January 11, 2016 Senate, No. 2301 (First Reprint)
Title B. Subtitle. Chapter F. (New) "Pharmacy Benefits Managers" - - C.B:F- to B:F- - Note P.L.0, CHAPTER, approved January, 0 Senate, No. 0 (First Reprint) 0 0 0 AN ACT concerning pharmacy benefits managers
More information