Federal and state policymakers are implementing a variety of strategies to address inappropriate prescription use in the treatment of injured workers, and the damaging effects of increased opioid use for pain treatment. Inappropriate use of prescription drugs has a negative impact on patient health and returning to work. Patients often stay out of work longer than those with similar injuries who take lower doses of opioid painkillers.
Texas and Ohio are originating states that created Workers’ Compensation drug formularies to address these issues. In addition to Texas and Ohio, Oklahoma, Washington, Tennessee, Arizona, and California have statewide drug formularies. Massachusetts, Indiana, Pennsylvania, and New York are contemplating developing them as well.
What Is a Drug Formulary?
A formulary in Workers’ Compensation is a list of drugs with a status indicator, which specifies if the drug is approved or requires pre-authorization by the claims administrator. Drugs that require pre-authorizations are typically drugs with the highest likelihood for abuse.
Health plan formularies have been around for a number of years, with the aim to strike a balance between drug safety, efficacy, and cost. Drug formularies for Workers’ Compensation, however, are still a relatively new objective.
While research has shown formularies are effective in decreasing prescription drug costs, along with reducing potentially-harmful prescription drugs, opponents feel they may increase drug usage and incentivize it.
Despite the reservations and hesitancy of opponents to implement formularies in their own states, several states have demonstrated the benefits of their respective formularies:
North Dakota has restricted medication use to those which have demonstrated safety, efficacy, and cost effectiveness.
Ohio experienced a 27.8% decline in opioid prescriptions and a 72.9% decrease in skeletal muscle relaxant prescriptions.
Texas has significantly curtailed drugs that require preauthorization before dispensing.
Washington’s prescription drug payments-per-claim were 40% lower than the average of other states studied.
So long as formularies are based on medical data and regularly maintained, supporters assert that they allow all stakeholders to have better authority over prescribing and keeping injured workers on the right path to recovery. With injured workers in the forefront as the most important stakeholder, supporters feel we will see more triumphs in the future.
Pennsylvania Drug Formulary Legislation
The Pennsylvania House of Representatives passed Senate Bill 936, which would amend the Workers’ Compensation Act to provide for the implementation of a prescription drug formulary for Workers’ Compensation claims. Additionally, it would establish a process for the certification or accreditation of Utilization Review Organizations for Workers’ Compensation claims.
Many have asserted that the bill jeopardizes medical treatment and makes it easier to deny coverage to injured workers in an attempt to profit insurance companies. Opponents further argue that the legislation is too vague, and because injured workers are in a special category, they should not be subject to formulary restrictions.
Governor Tom Wolf agreed with these opponents, and subsequently vetoed the bill.
The Gross & Kenny, LLP Workers’ Compensation Lawyers in Philadelphia Help Injured Workers
If you have been injured at work, contact the Workers’ Compensation lawyers in Philadelphia of Gross & Kenny, LLP. We can help determine if you are eligible for workers’ compensation benefits to help pay for medical expenses and replace lost wages. Call us today at 215-512-1500 or 267-589-0090. You can also complete an online form for a free consultation in our Philadelphia, Pennsylvania office.
This article was first published by Lawyers.com.
