This Tuesday, May 23rd, the Louisiana House of Representatives passed an ODG formulary bill for workers’ comp, 58-36. This morning, national industry publication WorkCompCentral (subscription required) published a piece which revealed that Governor John Bel Edwards will likely veto the bill if it reaches his desk.
Below is Office of Workers’ Compensation (OWC) Director Sheral Kellar’s response to the bill’s passage in the House and the WorkCompCentral article.
As director of the Office of Workers’ Compensation, I am grateful for the opportunity to discuss relevant workers’ compensation issues. Below is my response to the passing of HB 592:
Prescribing decisions and medications are best left to an injured workers’ treating physician. But, if HB 592 becomes law, it would establish the Official Disability Guidelines (ODG) Appendix A as the standard of care for dispensing medication to injured workers in Louisiana. It lists approximately 300 drugs that can be dispensed and prescribed for outpatient use. Most opioids are “N” drugs that can be prescribed, but are subject to prospective utilization review to confirm the drug is medically necessary for treatment of the injured worker before being dispensed.
How long must an injured worker wait to get an “N” drug prescribed by his physician? Experience tells us that it can often take as long as 90 days or more. An injured worker should not have to wait 90 days to receive medication to relieve pain.
Hydrocodone is listed as a “Y” drug on the ODG Appendix A list, while most other opioids are “N” drugs. Hydrocodone, therefore, can be prescribed and dispensed with no restrictions. Hydrocodone is also the No. 1 drug prescribed (by prescriptions counts) both in Louisiana and nationwide. Unrestricted and unlimited access to this “Y” drug does not further the expressed goal of HB 592 of curbing opioid abuse among injured workers. To suggest otherwise is disingenuous.
A pharmacy formulary is a tool that can be used to address the opioid issue. But it is not the only tool. In fact, Dr. Marcus Dillender, a Ph.D. from W.E. Upjohn Institute for Employment Research, suggests that careful management by insurers and administrators can achieve the same result.
Dr. Dillender’s opinion is supported by a June 2016 Workers’ Compensation Research Institute (WCRI) study, called Longer Term Use of Opioids, 3rd Ed. This study drew data from more than 300,000 nonsurgical workers’ compensation claims with more than seven days of lost time over the study period. The results were an observable decrease in longer-term use of opioids among injured workers in 25 states, most of which do not utilize a closed pharmacy formulary like ODG Appendix A.
Injured workers are entitled to the best medical care possible at an affordable cost to the employer, rather than the cookie-cutter approach required by HB 592.