Officials tasked with overseeing the workers’ compensation program for federal workers say they have created an effective pharmacy benefit management program that addresses concerns raised in a scathing report that found millions in overspending and prescriptions written for notoriously deadly fentanyl.
A review by the Office of Workers’ Compensation Programs, released April 4, found that the Federal Employees’ Compensation Act program, which covers injured federal workers, failed to ensure adequate pricing and clinical oversight of prescriptions , resulting in $321.3 million in overspending.
The review also found numerous other problems with the FECA program, including that it “lacked a pharmacy benefit manager to help keep costs down and had not determined whether alternative methods of pricing prescription drugs would be more competitive.”;
Outside auditors analyzed six years of drug data and studied policies, procedures and other documentation. They also compared the FECA program to industry practices and other worker skills programs.
Assisting with the audit was Maggie Valley, North Carolina-based consulting firm CompPharma LLC, which is led by Joe Paduda, its Skaneateles, New York-based president.
Mr. Paduda said the worst findings included 1,330 prescriptions for fentanyl, a fast-acting opioid that had been restricted but was still being prescribed. “A number of things that shouldn’t have happened actually happened,” he said.
Overall, the audit found that the FECA program paid for 12 separate controlled substances that are “considered dangerous and carry a high risk of psychological or physical dependence, abuse, and dependence,” including fentanyl — designated among the most dangerous.
– The concern here is really a patient safety issue. “Given all the notoriety that fentanyl has achieved, it’s no news to anyone that this is a really dangerous drug,” says Paduda.
“A policy or procedure where the payer ensured that prior authorizations were made would have prevented these fentanyl scripts from going to patients, for whom there is no evidence that they met the requirements.”
Auditors reviewed data from 2015 to 2020, and the Office of Workers’ Compensation Programs has since hired experts to help with its program, Office Director Chris Godfrey said in a statement.
“The Federal Employee Compensation Act program implemented a Pharmaceutical Benefit Management feature in late 2021, which addressed many of the issues raised by the OIG and significantly improved patient safety, quality of care for FECA claimants, and reduced pharmaceutical spending by $87.9 million in the first year alone. These improvements were not reflected in the OIG report, which covered a period prior to the implementation of PBM,” the statement said.