A A scathing report on one of the nation’s largest workers’ compensation programs highlighted the importance of utilization reviews, experts say.
An audit by the U.S. Department of Labor’s Office of the Inspector General of its Office of Workers’ Compensation Programs released last month found that the program failed to properly monitor prescriptions for about a dozen controlled substances, including fast-acting fentanyl that has been linked to overdose deaths. nationwide.
The review of 2015-2020 data focused on the Federal Employees’ Compensation Act program, which serves injured federal workers, and found that overall, FECA “lacked a pharmacy benefit manager to help contain costs and had not determined alternative methods for pricing prescriptions pharmaceuticals would be more competitive.”;
The review, which compared the federal program to comp practices nationwide, also found that the Office of Workers’ Compensation Programs lacked sufficient clinical expertise and guidelines to ensure appropriate medication decisions, which could negatively impact claimants’ health, recovery and return to work.
Maggie Valley, North Carolina-based consulting firm CompPharma LLC, led by Joe Paduda, its Skaneateles, New York-based president, assisted in the audit.
Mr. Paduda said the worst findings included 1,330 prescriptions for fentanyl, an 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,” according to the report.
– 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 that ensured prior authorization was done would have prevented the fentanyl scripts from going to noncompliant patients, he said.
The Office of Workers’ Compensation Programs has hired experts to help with its program since the period covered by the audit, the office’s director, Chris Godfrey, said in a statement.
“The Federal Employees’ 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.