State of the States November 1, 2024

National – Late last week, the CDC declined to endorse respiratory syncytial virus (RSV) vaccines for young adults, stating that their current guidelines are appropriate. The U.S. Center for Disease Control and Prevention (CDC) work group released its interpretations on RSV in adults. The CDC reaffirmed that RSV vaccination is recommended only for adults aged 75 and older, and for those aged 60-74 who are at risk of severe disease. 

 This week, Enlyte hosted a webinar on its Pharmacy Solutions Drug Trend report. The session included topics on how to best equip pharmacy programs to succeed, a deeper perspective on the top pharmacy trends, and a complete view of the in and out of network pharmacy trends. 

The American Academy of Pediatrics (AAP) has issued its clinical guidance on prescribing opioids for managing acute pain in youth on an outpatient basis. The guideline outlines steps pediatricians should follow when prescribing opioids to minimize the long-term risk of addiction. It also advises that naloxone, an overdose-reversal medication, be routinely prescribed with every opioid order. To learn more, check out this press release. 

WorkCompRecap released its 2023 Workers’ Compensation Benchmarking Study Report by Rising Medical Solutions. This report builds on a decade of research and analyzed surveys over 1,300 frontline claims professionals. It focuses on the skills and practices used for optimal claim outcomes, talent development and retention, the role of technology in claims management, and the medical management programs and provider quality metrics frontline staff consider crucial. 

House of Representatives Celeste Maloy (R-UT), Raja Kirshnamoorthi (D-IL), and Diana Harshbarger (R-TN) introduced HR 10050 the Pharmacist Audit and Compensation Transparency Act (PhACT). If passed, the bill would direct the Secretary of Health and Human Services to investigate how Pharmacy Benefit Managers (PBMs) audit pharmacists and make recommendations for more transparency and fairness. To learn more, check out this one pager.   

Healthsystems released their twice-annual industry journal, RXInformer. Designed as a guide for workers’ comp stakeholders, RXInformer addresses the industry’s most pressing topics. The Winter 2024-25 edition explores emerging issues in workers’ compensation healthcare, including the influence of cardiovascular comorbidities on prescription drug management for injured workers, cybersecurity challenges, and the significant impact of high-cost drugs on overall prescription drug expenditures.

New Jersey – S 1981 is currently in the Senate. 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.

New York – The New York State Workers’ Compensation Board is requiring a $24,000 fine from the New England Patriots for not having workers’ compensation coverage. The board states that the team failed to cover its players in New York from June 1, 2023, to September 22, 2023. Since the Patriots have payroll in New York, they must maintain workers’ compensation coverage in the state.

Pennsylvania – Right before Halloween, Governor Josh Shapiro (D) enacted SB 1232. As a reminder, the bill would make direct deposit the default method for paying workers’ compensation benefits. Specifically, the bill would allow insurers and self-insured employers to offer direct deposit and after a year, they would be required to use direct deposit unless the injured workers request otherwise.

Texas – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) released its 2024 Insurance Carrier Performance Based Oversight (PBO) results. The goal of the PBO is to set performance expectations, encourage improvement, and reward excellence. 130 insurance carriers were reviewed by the DWC and 44 had scores placing them in high performer tier while only 4 placed them in the poor performer tier. The full results and tiered list can be found on the TDI website.  

The Texas Department of Workers’ Compensation is now accepting comments on the 2025 Medical Quality Review Annual Audit Plan until November 22. This plan sets the priorities for the Medical Quality Review Panel and defines the scope, methodology, and selection criteria for the audits. Send your comments and suggestions to OMA@tdi.texas.gov. 

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