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Senate of Pennsylvania
Session of 2017 - 2018 Regular Session


Posted: October 11, 2017 03:14 PM
From: Senator Donald C. White and Sen. Joseph B. Scarnati, III, Sen. Mike Regan
To: All Senate members
Subject: Worker's Compensation Drug Formulary
The Philadelphia Daily News recently published a story titled “Flipping the Script: How Lawyers, Docs, and Drugstores Form Quite the Lucrative Alliance.” The article primarily focuses on the “unholy alliances” of a Worker’s Compensation law firm in Philadelphia. The article is attached for your reference

Recently, some law firms that specialize in Worker’s Compensation have purchased their own pharmacies. This has enabled them to refer clients to doctors with which they have referral agreements and, in turn, the doctors write prescriptions and send them to the pharmacy the firm owns. In addition to this ethically questionable practice, the article points out that arrangements such as these have led to increased prescriptions of opioids and expensive, unproven pain creams. While the Daily News article only addresses one Philadelphia law firm, the problem is statewide.

As a result, we will be introducing legislation requiring the Pennsylvania Department of Labor and Industry to adopt an evidence-based drug formulary for the PA Worker’s Comp program. The adoption of a drug formulary, which is commonplace in health insurance, will begin to reduce the over-prescription of opioid painkillers by setting evidence-based standards for the medication that can be prescribed for a Worker’s Comp patient. The legislation will also eliminate payments for overpriced, unproven pain creams as mentioned in the article.

In addition to lowering costs and providing better care for patients this proposal will greatly assist the Commonwealth in our battle against the opioid addiction crisis.

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. Furthermore, this standard of review, as well as drug formularies, are commonplace in all health insurance, including Medicaid and Medicare.

We welcome you to join us in sponsoring legislation that will ensure injured workers are prescribed the right medications and out of medical necessity, not merely as a profit motive.

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Introduced as SB936