Participants Spoke Candidly about Formulary Goals, Limitations of State-Based Statistics at Comp Blog’s November “Comp in Focus” Luncheon

Louisiana Comp Blog hosted its second “Comp in Focus” luncheon yesterday (November 17th, 2015) at Ralph’s on the Park in New Orleans.

The event, which aims to draw attendees from both the claimant/labor side of the workers’ compensation system and the employer/insurer sector, centered around a rousing discussion about formularies and the current Office of Workers’ Compensation Administration (OWCA) proposal here in Louisiana.

Elizabeth Lowry, Area Manager at CorVel Corporation’s office in Metairie (whose role includes leading three states for the national third party administrator, including Louisiana) started the afternoon off with an overview of the national formulary movement. Four states currently have formularies in place for workers’ comp claimants: Ohio, Texas, Washington and Oklahoma. Several other states, including Louisiana, are considering formularies on some level. Adding further weight to our local discussion, California, a national trendsetter and an outsize percentage of the general comp market, passed a law last month mandating a prescription drug formulary for covered employees. Its formulary will take effect by July 1st, 2017.

helios drug trends 2015

Helios Drugs Trends Report 2015

Lowry brought attendees through a variety of data from the Texas Department of Insurance and the Washington State Department of Labor and Industries, as well as reviewing the proposed formulary for Louisiana, which is tied to the Official Disability Guidelines (ODG) closed formulary, but over which the Louisiana Medical Advisory Council (MAC) would have final say.

Throughout the presentation, Lowry took questions and comments from “Comp in Focus” attendees, several of whom addressed each other directly and sounded off about their experience with the system and how a formulary could help or hurt. From the start, OWCA Director Patrick Robinson actively discussed his administration’s perspective on formularies and why such measures need to be considered in Louisiana. In particular, Robinson clarified that the chief purpose of his formulary proposal is to reduce the number of opioid prescriptions issued to injured workers in Louisiana. This goal was a constant refrain throughout the discussion, as most national data puts Louisiana at either No.1 or No. 2 in the country (usually jockeying with New York) for the amount of narcotics prescribed statewide, both generally and in comp.

However, the discussion of that stated purpose generated a lively debate, in light of the fact that states with formularies often use cost savings to determine the level of “success” that an implemented formulary has achieved. Daren Sarphie, a representative of injured workers with Workers’ Compensation LLC, in Metairie, voiced his concern that such data, in addition to revealing an institutional bias in favor of systemic expenditure reduction that can prevent injured workers from receiving sufficient care, does not offer a complete picture. Texas data was criticized by several attendees in this regard. Sarphie advocated for more comprehensive, integrated data collection efforts focusing on outcomes in the long term, rather than simply logging how many workers are technically released to return to work. This would, he argued, allow regulators to gain an understanding of how return to work and vocational rehabilitation efforts can fall short of actually returning the employee to gainful employment – a situation which can shift them into taxpayer-funded social safety nets like Medicaid.

In addition to these macro-level points, participants spoke to their hesitation on several practical issues with an ODG formulary in Louisiana, including how often and effectively the MAC could be expected to review and update the list, issues surrounding palliative care and associated opioid therapy, further delays in treatment than the current 1010 process, and administrative and legal burdens and challenges.

To conclude the meeting, Comp Blog held a door prize drawing after dessert for a pair of all inclusive floor seats to a New Orleans Pelicans game. Gwen Bourgeois, with NuQuest/Bridge Pointe, went home with the prize package.

The next “Comp in Focus” luncheon will be held in January. Louisiana Comp Blog will issue full details on that event in the coming weeks.

1 Comment

  • Troy Prevot says:

    Great Job Elizabeth and Nina!

    Measuring outcomes are critical both in measuring disability duration, productive RTW and yes costs too. Tasks force put together in the past have produced some progress but agendas’ end up getting in the way and the employee looses. we have to do better.

    Happy Thanksgiving!

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