A scathing report on one of the country’s largest workers compensation programs highlighted the importance of utilization reviews, according to experts.
A U.S. Department of Labor’s Office of Inspector General audit of its Office of Workers’ Compensation Programs that was released last month found that the program failed to properly oversee prescriptions for a dozen controlled substances, including fast-acting fentanyl that has been linked to overdose deaths nationwide.
The audit 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 if alternative prescription drug pricing methodologies would be more competitive.”
The audit, which compared the federal program with comp practices nationwide, also found that the Office of Workers’ Compensation Programs lacked sufficient clinical expertise and guidelines to ensure appropriate pharmaceutical decisions, which could negatively affect claimants’ health, recovery and return to work.
Maggie Valley, North Carolina-based consultancy CompPharma LLC, headed by Joe Paduda, its Skaneateles, New York-based president, assisted with the audit.
Mr. Paduda said the worst findings included 1,330 prescriptions for fentanyl, an opioid that had been restricted but was prescribed nonetheless. “A number of things that should not have happened did, in fact, happen,” 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 for psychological or physical dependence, abuse and addiction,” according to the report.
“The concern here is really a patient safety issue. Given all of the notoriety fentanyl has achieved it’s not news to anybody that this is a really dangerous medication,” Mr. Paduda said.
A policy or procedure that ensured prior authorizations were done would have prevented the fentanyl scripts from going to patients who do not meet the requirements, 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 function in late 2021, which addressed many of the issues raised by OIG and significantly improved patient safety, quality of care for FECA claimants, and reduced drug 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 the PBM,” the statement said.