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Pennsylvania drug formulary gets pushback from trial lawyers

Pennsylvania drug formulary gets pushback from trial lawyers

A Pennsylvania bill mandating a drug formulary for workers compensation that passed the state’s senate last week has been welcomed by insurer advocates but is opposed by trial lawyers, who say it’s an attempt to curb utilization review organizations.

Under S.B. 936, passed Oct. 25 on a 34-16 vote, the Pennsylvania Department of Labor and Industry would select a “nationally recognized, evidence-based prescription drug formulary appropriate for resolving issues related to drugs prescribed for or related to the treatment of work-related injuries, including, but not limited to, the type, dosage, and duration of prescriptions,” according to the bill’s latest text. 

Pennsylvania is the latest state to introduce legislation to create a workers comp drug formulary. Formularies have long been used by medical insurers to control prescription costs by listing the drugs that insurers will cover. 

The bill also requires utilization review organizations to be nationally accredited or certified. The bill is an attempt to control the decisions of utilization review organizations through the cost of getting certified, said Larry Chaban, a Pittsburgh-based workers compensation attorney and member of the Pennsylvania Association for Justice, a trial lawyer organization. 

Utilization review organizations are accredited entities that insurers, employers and patients can call on to review the appropriateness of a course of treatment. 

The bill also does not address the issue of opioids and reduces physician choice, Mr. Chaban said. 

“A formulary is going to deal not just with opioids. We suggested that they just deal with opioids and they didn’t want to do that. They wanted a complete formulary. An overwhelming percent of the drugs that are ordered for treatment of work injuries based on our research are not opioids…and it will affect all the other prescriptions written by doctors reducing physician choice,” he said. 

But insurance trade associations, including the Insurance Federation of Pennsylvania and the American Insurance Association, support the bill. 

The bill requires that all utilization review organizations used by state authorities meet nationally recognized accreditation standards, said Sam Marshall, president and CEO of the Insurance Federation of Pennsylvania. “What it does is bring a consistent and high quality of medical care to injured workers,” he said. 

“Formularies are a critical part of reducing the dangers to injured workers caused by inappropriate pharmaceutical prescriptions. States are starting to see the advantages to the treatment of injured workers and the workers compensation systems when such policies are enacted,” Steve Bennett, Washington-based associate general counsel for the American Insurance Association, said in an emailed statement. 

The Pennsylvania Association for Justice offered amendments to the bill on the Senate floor that were rejected, Mr. Chaban said.

“One of them was limiting the cost of compound creams to 10% over the actual cost to the pharmacy, and we also offered an amendment that would require doctors to check the opioid registry before they wrote a prescription for opioids,” said Mr. Chaban.

S.B. 936 will now go to the state House of Representatives. 





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