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Senate of Pennsylvania
Session of 2017 - 2018 Regular Session


Posted: May 2, 2018 10:30 AM
From: Senator Donald C. White and Sen. Joseph B. Scarnati, III, Sen. Kim L. Ward
To: All Senate members
Subject: Curbing Overprescribing of Pain Medication in Workers' Comp
We will soon introduce legislation that will reduce the over prescription of pain medication in the Worker’s Compensation System by statutorily requiring prescription guidelines and effective utilization review.

This legislation will codify the key components of Governor Wolf’s recently announced executive action to curb opioid abuse in Workers’ Comp. Pennsylvania is in the midst of an opioid epidemic and swift legislative action is needed to provide appropriate statuary authorization to implement the reforms the Governor suggested.

Specifically, the legislation will require the Department of Labor and Industry, in consultation with the departments of Health, Drug and Alcohol Programs, and the appropriate licensing boards, to develop evidenced-based prescribing guidelines for the prescription of pain medication prescribed for work related injuries in the Worker’s Compensation System.

The prescribing guidelines will apply to ALL pain medication prescribed in Workers’ Comp. As Governor Wolf noted, costly topical compound drugs with unknown safety and efficacy have led to staggeringly high costs. However, since many topical compounds are not opioid-based, limiting prescribing guidelines to only opioids is misguided and will not fully address the problem.

To further eliminate overpayment for unproven topical compounds, my legislation will cap the price of compounded drugs at 110% of the average wholesale price of each ingredient in the compounded drug.

The bill will also require the use of Utilization Review Accreditation Commission (URAC) certified utilization review organizations to provide consistency to the utilization review and adjudication processes with regard to utilization issues, such as prescription drug abuse. This standard of review, as well as prescribing guidelines, are commonplace in all health insurance, including Medicaid and Medicare.

Finally, our legislation will direct the Pennsylvania Compensation Rating Bureau and the Insurance Department to ensure any insurer cost savings achieved through this act are passed on to the payer.

Introduced as SB1187