Pharmacy Formulary Debate Pits Two Bills Against Each Other – ODG vs. Louisiana-specific

Two closed pharmacy formulary proposals have been filed so far in this year’s Regular Session, which began April 10th and concludes June 8th. One measure, HB 592 by Representatives Talbot, Barras, Davis and Lance Harris, requires the use of the Work Loss Data Institute’s Official Disability Guidelines (ODG) Appendix A. The other, HB 529 by Representative Broadwater, does not require the Louisiana Workforce Commission to implement any specific formulary, but rather, would more broadly ask the LWC and Office of Workers’ Compensation Administration (OWCA) to create one with input from a range of system stakeholders. Both proposed formularies incorporate a grace period for legacy claims and a variance procedure.

Broadwater, who filed an ODG formulary bill last session and has been outspoken about the need to address opioid abuse and addiction among injured workers, said in an interview with Louisiana Comp Blog in April of last year that, “The specific formulary is not as important to me as putting something out there to raise some eyebrows – fix it, or else I’ll point out to my colleagues that I’ve asked and [the stakeholders] failed.”

The 2016 Broadwater bill never got a hearing in the House Labor and Industrial Relations Committee last year after being rejected by the Workers’ Compensation Advisory Council (WCAC). The Council, which is tasked with reporting bills favorably or unfavorably to the Committee before hearings are set, will listen to information about both formulary bills on Thursday, April 27th. ODG has been a sticking point among injured workers and their representatives for years, so this more general version of the concept from Broadwater may fare better.

For his part though, Trey Mustian, President of Louisiana Workers’ Advocates (LWA), disagrees with the notion entirely. “LWA opposes [both] formulary bills. A primary reason is that the formulary, which has only been adopted in a handful of states, is overkill in its stated purpose of reducing opioid use,” he explained. “There are several bills this session aimed at reducing opioid prescriptions, increasing prescriber participation in the pharmacy management program, and increasing prescriber education in the best opioid prescribing practices. The real reason the proponents want the formulary is to drastically reduce costs of prescription drugs.”

Whether or not workers’ comp needs additional regulatory measures to halt opioid abuse or not has been an issue in the past. A tense exchange between OWCA Director and WCAC Chair Sheral Kellar and Louisiana Association of Self-Insured Employers (LASIE) Executive Director Gary Patureau during one meeting of the Louisiana Commission on Preventing Opioid Abuse, revealed these differences among stakeholders. The two sparred in January over singling out the workers’ comp system for a formulary in the Commission’s draft recommendations. Patureau’s formulary proposal did not make it into the final report.

From left: Talbot, Broadwater

Commenting via email to Louisiana Comp Blog about this year’s bills, Patureau remained convinced of a formulary’s necessity. “Injured workers would directly benefit by being prescribed the best medicine for their medical conditions and, in many instances, those employees will avoid the dangers of addiction and becoming additional statistics in the nationwide opioid epidemic. HB 592 is the preferred approach, because it establishes the ODG pharmacy formulary, which has a proven track record of success.”

The success story to which Patureau refers is Texas’ experience with ODG’s Appendix A, which the state chose to implement in 2007. “After its adoption in Texas, prescriptions for non-preferred opioids dropped by 81 percent,” he said. “The formulary has also reduced the number of injured workers receiving extremely high dosages of non-preferred opioids [identified as ‘N’ drugs in the ODG formulary which require extra approvals] from 15,000 to less than 500.”

However, referring to the same data, which was echoed in the Workers’ Compensation Research Institute’s (WCRI) 2014 study, Impact of a Texas-like Formulary in Other States, Mustian painted a different picture, accusing employers and insurers of looking at the bottom line without considering the needs of workers and their doctors.

“Texas has seen a 65 percent drop in prescription drug costs due to its formulary,” Mustian said. “The Medical Treatment Guidelines [here in Louisiana] have been an administrative nightmare for physicians and patients. The formulary would extend that nightmare to prescription drugs.”

Agent organizations are generally expected to support at least one of the formulary bills.

Louis Fey, President-elect of the Louisiana PIA, said that his organization supports both bills, adding that the opioid abuse crisis “has hit critical mass” and that he trusts Representative Talbot’s judgment. “Insurance Committee Chairman Talbot currently sits on the P&C Commission and was moved to propose his bill as a result of what we heard from industry experts, including experts at the state and federal levels, as well as from representatives that discussed the Texas drug formulary program,” Fey explained.

Indeed, Talbot, when asked about the impetus for including ODG in his formulary bill despite the fact that Broadwater’s ODG bill failed last year, explained: “The main reason is because, first of all, there aren’t that many formularies out there in the first place. Texas has the data, so instead of reinventing the wheel, we can look at another state and see what they did. I’m not saying that [the Louisiana formulary] has to be ODG – but I like what I saw there [in Texas].”

IIABL (AKA the Big I) CEO Jeff Albright said that his organization has not yet taken a position on the bills and was still gathering information.

Keep up with all the bills we are tracking with the 2017 Comp Blog “Comp in the Capitol” series here.

 

 

Editor’s Note: When asked about WCRI’s position on the ODG formulary, John Ruser, President and CEO of WCRI wrote in an emailed statement: “WCRI does not take positions in support or opposition to any public policy issue. WCRI has conducted some research in the past on the ‘Impact of a Texas-like Formulary in Other States.’ This research was not meant to endorse the Texas formulary approach, but to provide information about expected results in other states, were the Texas approach to be adopted.”

 

 

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