Bill Creating Workers’ Comp Drug Formulary Advances in Louisiana

A bill establishing a workers’ compensation closed drug formulary in Louisiana passed the House and has been referred to the Senate Committee on Labor and Industrial Relations.

A legislative analysis of House Bill 592 by states that the law currently in place “requires the development of medical treatment guidelines for workers’ compensation claims and requires a process for office of workers’ compensation administration to review and promulgate rules and regulations to ensure proper care for the injured worker.” HB 592 would add to current law by requiring the pharmacy formulary to be established, according to the legislative statement.

Under HB 592, by Rep. Kirk Talbot (R-District 78), the Work Loss Data Institute’s Official Disability Guidelines (ODG) Appendix A and supporting documents would serve as the basis for the standard of care for dispensing medication to injured workers.

Proponents see the formulary as a tool for combating the over use and abuse of opioids in the state, which has high levels of opioid prescriptions in the workers’ comp system, according to the Louisiana Property Casualty Insurance Commission (LPCIC).

Opponents say it is simply a way for workers’ comp insurance providers to lower their costs and will not significantly improve rehabilitation results for injured workers.

In its annual report for 2016/2017, the LPCIC included a study by the Workers’ Compensation Research Institute showing that of the 25 states in WCRI’s study, Louisiana has the second highest use of opioids in workers’ compensation. The WCRI found that around 85 percent of injured workers receiving pain medications received opioids. One in six injured workers in Louisiana that received opioids were found to have had the drugs prescribed to them on a long-term basis.

Insurance Commissioner Jim Donelon said in a September 2016 Louisiana Department of Insurance release that the high frequency of opioid use among injured workers compared with other states “is a dangerous trend that has reached crisis proportions.” He said in addition to the high costs to “individuals and families that these drug abuses and opioid dependencies cause, there is also a cost to the insurance system as a whole.”

The LPIC recommended in its annual report for 2016/2017 that the legislature enact a bill requiring a closed pharmacy formulary in workers’ compensation claims.

Not everyone is on board with the prospect of establishing the closed formulary as proposed in HB 592, however.

In a statement published in the Louisiana Comp Blog, Sheral Kellar, the state’s director of the Office of Workers’ Compensation, called the formulary proposed in HB 592 a “cookie cutter approach,” and said the bill as written would not fulfill its promise of curbing opioid abuse in the comp system.

Part of the problem with the formulary’s reliance on the ODG is its classification and utilization standards for opioid-type drugs, according to Kellar. She wrote that the majority of “opioids are classified as ‘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.” An extended utilization review can result in the injured worker having to wait as long as 90 days to receive pain medication.

Kellar also wrote that hydrocodone, one of the most prescribed and dispensed opioid-type drugs, is classified as a “Y” drug, which “can be prescribed and dispensed with no restrictions.” She argued that unrestricted access “to this ‘Y’ drug does not further the expressed goal of HB 592 of curbing opioid abuse among injured workers.”

She suggested that by carefully managing pain management practices in the comp system, insurers and administrators can achieve the desired result of lowering the use and abuse of opioids.

Topics Workers' Compensation Louisiana