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House of Representatives
Session of 2017 - 2018 Regular Session


Posted: February 8, 2017 04:42 PM
From: Representative Ryan E. Mackenzie
To: All House members
Subject: Workers' Compensation Drug Formulary
In the near future I will be introducing legislation to reduce instances of opioid abuse and addiction stemming from our Workers’ Compensation Program (WC).

Last session, I introduced House Bill 1800 to require comprehensive evidence-based treatment guidelines, including a drug formulary, in our WC program. After a hearing was held on this bill and extensive discussions regarding opioid addictions, the idea of just introducing drug formularies garnered the most interest and bi-partisan support.

My legislation would require the Pennsylvania Department of Labor and Industry (L&I) to adopt an evidence-based drug formulary for our WC program. The adoption of a drug formulary can begin to reduce the over-prescription of opioid painkillers by setting evidence-based standards for the medication that can be prescribed for a WC patient.

Several states around the country have adopted drug formularies for their WC programs to help reduce the misuse of prescription opioid drugs. A June 2016 study by the Workers’ Compensation Research Institute found that out of 25 states studied Pennsylvania had:
  • the third highest amount of opioids prescribed per injured worker;
  • the second highest number of opioid pills per prescription per claim;
  • a morphine-equivalent average per injured worker 78% higher than the median state studied;
The drug formularies will be continually updated as new research is reviewed and new evidence indicates a particular drug is appropriate for a diagnosis. L&I will be required to make all formularies adopted by the department available online to the general public. A physician treating an injured worker will also be able to access the formulary online or through specialized software to determine if a medication is consistent with a patient’s diagnosis. If a drug is not consistent with the formulary, it does not necessarily mean that the medication will be denied to the patient, but rather, it will require additional substantiation to ensure it is needed for the diagnosis.

The bill will also require standards for UROs (Utilization Review Organizations) and PROs (Peer Review Organizations) to ensure that these entities meet the same certification requirements as the organizations that conduct utilization review for other types of health insurance. These standards will help to provide consistency to the utilization review and adjudication processes with regard to utilization issues, such as prescription drug abuse.

I believe this legislation will help prevent injured Pennsylvania workers from becoming addicted to opioid drugs. Please join me in co-sponsoring this important piece of legislation. I will be introducing this at the close of business on Friday, February 10th.

View Attachment

Introduced as HB18