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House Co-Sponsorship Memoranda
House of Representatives
Session of 2021 - 2022
Regular Session
MEMORANDUM
| Posted: | November 1, 2021 04:09 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 Workers’ Compensation Programs (WC). Although the COVID-19 pandemic has overshadowed the opioid crisis for the last year, Pennsylvania is still a national leader in overdose deaths. The Morning Call recently reported that the commonwealth is third in overall deaths and sixth in the number of deaths per 100,000 residents. The construction industry has been hit particularly hard. A January 5 Wall Street Journal article cited a 2019 Barclays Research report that found workers in the construction industry were six times more likely to become addicted to opioids than workers in other manufacturing, industrial, and service industries. My legislation would require the Pennsylvania Department of Labor and Industry (L&I) to adopt an evidence-based drug formulary for our WC program. Unlike the formulary (preferred drug list) implemented by Governor Wolf for the Medicaid program, which is designed to save costs and push patients toward generic medications, the WC drug formulary will be based on medical evidence of whether the drug is effective for a specific condition. 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. 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. In addition to helping reduce the over-prescription of opioids and other frequently abused medications, a drug formulary will help to combat price gouging schemes. These schemes include those charging thousands of dollars for a tube of ineffective compound pain creams, or packaging multiple low-priced medications together in a “convenience package” at a markup of several hundred percent. This type of continually evolving price gouging provides no benefit to injured workers but increases the cost of workers’ compensation for the sole purpose of allowing a few bad actors to line their pockets. Finally, my bill will 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. |