An audit by the U.S. Department of Labor’s Office of the Inspector General of its Office of Workers’ Compensation Programs found that the program failed to ensure adequate pricing and prescription oversight for the program, resulting in $321.3 million in overspending.
In a report issued Tuesday, the audit found numerous problems with the Federal Employees’ Compensation Act program, which covers federal and postal workers, including that it “lacked a pharmacy benefits manager to help contain costs and had not determined alternative methods for 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 best practices and other workers̵7; compensation programs.
In addition to identifying overspending during the audit period between 2015 and 2020, auditors found that OWCP did not effectively monitor drug policy changes to ensure implementation, resulting in claimants receiving thousands of inappropriate prescriptions and potentially lethal drugs, including 1,330 prescriptions for rapid-acting fentanyl, even after to have issued a policy restricting its use.
The audit also found that OWCP failed to monitor prescription drugs that are carefully reviewed and rarely covered by workers’ compensation programs, and likely overused drugs “that may not have been necessary or appropriate.”
Auditors also found that OWCP lacked sufficient clinical expertise and guidelines to ensure appropriate medication decisions, which could have a negative impact on claimants’ health, recovery and return to work.
The report included recommendations to strengthen the management of drugs in the FECA program, including ensuring adequate clinical expertise among staff and using evidence-based clinical guidelines to create prescription drug coverage policies. According to the report, OWCP “generally agreed with the recommendations.”