The latest meeting of the Louisiana Commission on Preventing Opioid Abuse featured a discussion of a potential formulary for workers’ compensation which was ultimately scrapped. Office of Workers’ Compensation Administration (OWC) Director Sheral Kellar and Louisiana Association of Self-Insured Employers (LASIE) Director Gary Patureau sparred over singling out workers’ comp in the Commission’s draft recommendations.
The meeting on January 19th at the Department of Health in Baton Rouge was intended to be a discussion about the draft recommendations submitted by each of the eight “teams” to Commission co-chairs Malcolm Broussard of the Louisiana Board of Pharmacy and Eric Torres of the Louisiana State Board of Medical Examiners.
Based on the way the resolution which created the Commission is structured (HCR 113), each team is responsible for addressing one part of the opioid epidemic – an action area – and issuing recommendations for which the members of that team are supposed to hold a vote. The team-approved recommendations were then forwarded to Broussard and Torres to develop the draft. Broussard noted at the start of the meeting that it was essential to make progress on reaching consensus on the draft, as the Commission is already going to miss its February 1st deadline.
The controversy over a comp-specific formulary sprung up from the last recommendation in the third team’s section of the draft. Both LASIE and the Louisiana Workforce Commission/OWC are members of that team, which is tasked with evaluating and recommending “reasonable alternatives to medical treatment to mitigate the overutilization of opioid medications, including integrated mental and physical therapy health services.”
Recommendation on pharmacy formulary contested
The recommendation in the draft for Team 3 yesterday read: “Adopt a pharmacy formulary by legislation in the Louisiana Workers’ Compensation system.” Prior to the meeting, Director Kellar objected to the inclusion of this item via email to the Commission members, saying that she disagreed with the recommendation and felt that the team process had not been respected because no one had voted on the matter before it was submitted to Broussard and Torres.
Kellar wrote in part, “I believe this amendment [on the formulary] was submitted outside the presence of Team 3 members who have not had an opportunity to vet the recommendation […] I suggest that recommendation 3.6 should not be made a part of the draft until it is voted on by all Team 3 members. We were divided into teams to come to a consensus rather than to allow one member to unilaterally advance a recommendation.”
Broussard introduced the pharmacy formulary recommendation to the attendees and explained the dispute and then opened the floor.
Paul Hubbell, representing the Society of Interventional Pain Physicians of Louisiana, who joined the meeting by teleconference, was the first to weigh in against the recommendation. He explained that in the realm of workers’ comp, the Medical Advisory Council (MAC) for workers’ comp was already looking at formulary issues, and that he felt the authority of both that body and the Workers’ Compensation Advisory Council (WCAC) was being usurped by the inclusion of the issue. Hubbell explained, “The MAC is already looking at this […] any formulary will be done by doctors, not by insurance companies.”
Gary Patureau explained why he submitted the formulary recommendation in the context of Kellar’s emailed objection. “The reason why we brought this to Team 3 is because this an issue among injured workers. One of the challenges we face in Louisiana is getting our injured workers back to work, and use of opioids in the workers’ compensation system is part of the reason for that. It is a relevant part of opioid use and abuse in Louisiana,” he said. “It was implied that we didn’t follow the process. Information was sent out to the Committee with backup research – not a one person on the Committee replied one way or another, including [the representative of] the Louisiana Workforce Commission.”
Director Kellar countered that her email constituted an objection to Patureau’s recommendation, and then elaborated on her email, saying that she believed it was not the place of the opioid commission, which is meant to address the entire patient population of Louisiana, to specifically name workers’ comp patients as a special case in the final report.
Kellar explained: “Mr. Patureau full well knows that last year, a formulary bill was brought before the Legislature and vetted before the Workers’ Compensation Advisory Council and that bill was voted down […] Injured workers make up only a small percentage of the population that uses opioids. The mandate of this Commission is to come up with evidence-based strategies to address the overutilzation of opioids for Louisiana residents. There’s nothing in HCR 113 that talks about workers’ compensation. While I agree that it is a problem in the workers’ compensation community, it is only a small problem with respect to the general population.”
Formulary removed from draft after debate
Several other Commission members, including Jennifer Marusak of the Louisiana State Medical Society agreed with Kellar, saying that if one group is singled out then they all have to be named in the report, and that the purpose of the Commission is not to determine anything but general best practices to tackle the opioid epidemic.
After some further discussion between Patureau and Kellar regarding both the voting process within teams and the formulary issue itself, Broussard took a series of straw polls asking the assembled members if they support any mention of workers’ comp or of the recommendation as written. Patureau was the only one who supported the recommendation as written, two others said they would support naming workers’ comp in the report in some manner. Given those results, Team 3 leader Shelly Esnard (representing physician’s assistants) agreed to remove the formulary issue from the Team 3 draft entirely.
The results of this debate likely mean that workers’ comp will not be addressed in either any further drafts or in the final report.
The next meeting of the Commission is Monday, February 20th, at the Bienville Building | Department of Health in Baton Rouge beginning at 1:30 PM.