The August meeting of the Workers’ Compensation Advisory Council (WCAC) held yesterday at the LABI conference center in Baton Rouge centered around the potential implementation of a closed formulary for workers’ comp based on the Work Loss Data Institute’s “Official Disability Guidelines.”
Although the Council itself lacked a quorum, the public audience was full of both the usual Louisiana stakeholders and several national figures present to support the implementation of a formulary for our state. Ken Eichler, Director of Regulatory and Outcome Initiatives for the Work Loss Data Institute/ODG, presented the ODG formulary strategy and the tools associated with it, urging the Council and audience to consider it as a “quality of care” issue rather than a “cost-savings” effort.
Eichler spent much of his time on the floor emphasizing Louisiana’s opioid problem, citing CDC statistics that show Louisiana jockeying with New York for the state with the highest number of opioid prescriptions amongst the general population. Eichler argued that formularies are a growing national trend because they can act as both an expeditious route to getting faster approvals for prescriptions and can ensure that workers are receiving appropriate care. He also pointed to the low cost of implementation as a benefit, explaining that although carriers and physicians might choose to purchase an ODG subscription, the Louisiana Workforce Commission/Office of Workers’ Compensation Administration would be able to post the full formulary list on the agency website and that there wouldn’t be ecessive fees associated with the adoption.
However, although the “evidenced based” refrain was a constant in Eichler’s informational pitch, some stakeholders were suspicious of how such an “evidence-based” formulary could be used to “cut off” certain prescriptions, especially opioids, from chronic pain patients in the system. More than one member of the public referenced suicides of clients and patients prompted by the denial of their narcotic and/or antipsychotic medications. In response, Eichler insisted that weaning and tapering programs should be used and that variances could be submitted (under the current draft proposal of regulations) so that certain chronic pain patients could stay on their current regime, but some stakeholders were not convinced.
“You mean the variances that we can’t get?” Steve Wanko of the Wanko Law Firm and current President of Louisiana Workers’ Advocates asked. Wanko was referring to the testimony of Medical Director Dr. Christopher Rich in the 19th JDC constitutionality case against the LWC/OWC, in which he stated that variances were “basically impossible” to obtain under the Louisiana Medical Treatment Guidelines. In the same vein, Janice Barber (one of the claimant attorneys named as a plaintiff in the same constitutionality suit) questioned whether or not the formulary was a cost-shifting scheme in which workers would be denied “the medications that give them some form of functionality so that they can go to work” and ultimately be allowed to fall through the cracks. Both of these questions prompted outbursts insisting that long term opioid use is “not good medicine in the first place,” and thus, should be subject to new restrictions and possible correction under the “evidence” in the ODG formulary.
In a different critical avenue, WCAC member and orthopedic surgeon, Dr. Dan Gallagher of Marrero, expressed concern that the Medical Advisory Council (MAC) would have difficulty updating the formulary on a sufficiently regular basis for logistical reasons, and saying that the MAC would likely be uncomfortable with simply allowing updates to the list of “Y” (approved) and “N” (restricted) drugs without reviewing them first.
Additional discussion is to follow. See the draft formulary regulations and Eichler’s presentation below.