State of the States December 6, 2024

National – Enlyte has published the latest edition of its Quarterly Medical Price Index (MRI) report. The insights are drawn from Enlyte’s observations of charges and trends in professional service medical bills from Q1 2020 to 2024. 

Kids’ Chance of America released its 2024 Annual Impact Report. This non-profit organization provides educational scholarships and support to children of workers who are seriously or fatally injured on the job. The report highlights the past year's accomplishments and guides the future direction of Kids’ Chance.  

The Business Insurance World Captive Forum will be held February 5 through the 7th in Orlando Florida. This year the conference will feature, 28 educational and networking sessions, 78 expert speakers, 530 attendees, 16 countries, 42 states, 293 companies, and 170 captive owners. To learn more, check out the conference agenda, and register here.  

The Occupational Safety and Health Administration (OSHA) has extended the public comment period for its proposed heat rule to January 14th. As a reminder, this rule, initially proposed in July, requires employers to develop an injury and illness prevention plan to manage heat hazards in workplaces affected by excessive heat. Employers must also provide safe drinking water and rest breaks. To learn more, click here. 

The House of Representatives has asked the Department of Justice (DOJ) to investigate the role that pharmacy benefit managers (PBMs) may have played in the opioid crisis. At the end of November, Representatives Earl L. “Buddy” Carter (R-GA), Raja Krishnamoorthi (D-IL), Deborah K. Ross (D-NC), and Cliff Bentz (R-OR) sent a letter to Attorney General Merrick Garland. The letter points to recent reports suggesting that the three largest PBMs—CVS Caremark, Express Scripts, and Optum Rx—colluded to funnel patients toward OxyContin prescriptions. It highlights concerns that these PBMs increased their profits by steering patients towards opioids like OxyContin in exchange for substantial rebates from pharmaceutical companies. The letter calls on the DOJ to hold these PBMs accountable for their actions, which are alleged to have contributed to the overprescribing and distribution of opioids. To learn more, check out Representative Buddy Carter’s press release here.  

The Workers’ Compensation Research Institute (WCRI) has published the 25th edition of its CompScope™ Medical Benchmarks report. This report analyzes medical payments, prices, and utilization across various states, comparing them to 16 other states. Here are two key points worth noting: 

• CompScope™ Medical Benchmarks for North Carolina revealed that medical payments per claim for treating injured workers under workers’ compensation in North Carolina decreased in 2022, while many other states experienced an increase in medical payments during the same period. 

• CompScope™ Medical Benchmarks for Minnesota revealed that medical care for workers injured in Minnesota seems to be getting back on track after the COVID-19 pandemic. This is shown by higher medical payments per claim and a steady or slightly increased use of most services. 

The 340B Transparency Act (H.R. 3290) remains in the House of Representatives. This bill aims to improve oversight of the 340B drug discount program by requiring covered entities to report detailed information on their use of 340B savings. The bill also authorizes audits by the Secretary of Health and Human Services. It mandates public disclosure of the reported data to ensure transparency and proper use of the program’s benefits. 

Florida – Florida Insurance Commissioner Mike Yaworsky issued a final order approving the National Council on Compensation Insurance’s (NCCI) 1.0 percent statewide decrease in workers’ compensation insurance rates. This rate reduction, effective January 1, 2025, applies to both new and renewal policies.

Missouri – Missouri HB 327 was introduced in the State House to enhance drug regulations and transparency within the pharmaceutical industry. The bill aims to improve transparency and accountability by requiring pharmaceutical companies to disclose detailed pricing information, including the costs of research, development, and marketing.

New Jersey –  There are two committee hearing meetings on December 9th:  

• Before the Senate Budget and Appropriations Committee S 1192 will be discussed. As a reminder, S 1192 if passed, would require prescription drug coverage for serious mental illness without prior utilization or authorization management. According to the bill text, serious mental illness would include: bipolar disorders (including hypomanic, manic, depressive, and mixed), depression, major depressive disorders, obsessive-compulsive disorders, paranoid and other psychological disorders, schizo-affective disorders, as well as schizophrenia and PTSD.  

• Before the Senate Health, Human Service and Senior Citizen Committee S 1981. As a reminder, S 1981 aims to increase the accessibility of vaccinations and streamline the process within pharmacies. Specifically, the bill would expand the authority of pharmacy technicians and other pharmacy staff to administer drugs and vaccines. 

Pennsylvania – The Pennsylvania Compensation Rating Bureau (PCRB) has released its Prescription Drug Report, which examines trends in workers’ compensation prescription drug payments in Pennsylvania from 2012 to 2022. The report analyzes current patterns of prescription drug use among workers’ compensation claims across the state, using data from the Pennsylvania Medical Data Call to illustrate these trends with graphics and charts.

Texas – The Insurance Council of Texas has unveiled its Workers’ Compensation Annual Report for 2024. The report highlights that the workers’ compensation market remains one of the few consistently profitable lines in the state. To learn more, check out this Insurance Journal article.  

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