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A Tale of Two Formulary Bills and Controlling Opioids in the Pelican State

by
Optum Workers' Comp
| Apr 13, 2017

The 2017 General Session of the Louisiana legislature got off to a running start on Monday, April 10th. Legislators in the Pelican State will be considering two competing workers’ compensation drug formulary bills. HB 592, sponsored by Representative Kirk Talbot, has garnered the support of a number of the industry trade groups. As currently drafted, HB 592 calls for the creation of a pharmacy formulary based on the Work Loss Data Institute’s Official Disability Guidelines (ODG). The legislation would require the Director of the Office of Workers’ Compensation Administration to develop rules to implement the formulary and make it operational for new claims by January 1, 2018. Claims with a date of injury prior to January 1, 2018, would have six months to transition injured workers to approved or “Y” drugs, or to have authorizations in place to continue current pharmacy care. 

Simultaneously, Representative Chris Broadwater has introduced HB 529. The bill calls for the creation of a closed formulary for workers’ compensation claims. Rather than defining what the formulary would look like, HB 529 requires the Director of the Office of Workers’ Compensation Administration (OWCA) to “engage with employers, insurers, private sector employee representatives, public sector employee representatives, treating physicians actively practicing medicine, pharmacists, pharmacy benefit managers, attorneys who represent applicants, injured workers, and any other stakeholder the director deems appropriate to facilitate the development of the formulary.” The legislation would leave the development of the formulary and associated rules to the Director. HB 529 also sets forth an effective date of January 1, 2018, for new claims, and a transition period for legacy claims. The transition period would be defined by rule. 

These bills are not the first attempt at adopting a drug formulary in Louisiana.  Representative Broadwater sponsored HB 725 in 2016. The bill was referred to the House Labor and Industrial Relations Committee where it remained pending for the session. In 2015, Senator Daniel Martiny introduced SB 256, which was assigned to the Senate Health and Welfare Committee where it, too, was left pending until the end of the session.  The former Director of the Office of Workers’ Compensation Administration, Patrick Robinson, also promoted a Texas-style ODG formulary and submitted a draft rule to the Louisiana Workers’ Compensation Medical Advisory Committee for their consideration. The Committee failed to endorse the rule. 

Could 2017 be the year that Louisiana moves toward the adoption of a drug formulary for their workers’ compensation system? In a classic “best of times – worst of times” scenario, the best case is a real chance that one of the two formulary bills could go the distance and land on the Governor’s desk. However, on the worst case side, there is still some stiff opposition to the idea from physicians and applicant attorneys. And the current Director of the OWCA has not publicly endorsed either bill or the concept. The real wrinkle is HB 192, introduced by Representative Helena Morena. HB 192 would limit the initial prescription of opioids for acute pain to seven days. This bill would apply across the broad spectrum of health care. Opponents of the drug formulary concept are pointing to this bill as the preferred alternative for controlling opioids in the workers’ compensation system while saying the drug formulary bills go too far in limiting medications for injured workers. 

The use of opioids is a significant challenge in Louisiana, but they aren’t the only problem when it comes to escalating pharmacy costs in their workers’ compensation system. Physician dispensing, compounded medications and medication over-utilization in general are all contributing to rising and excessive costs. Bills limiting the supply of opioids and promoting drug formularies for the workers’ compensation system are not mutually exclusive. The opioid limit bill, HB 192, addresses the opioid crisis in all sectors of health care, including workers’ compensation. Either of the two drug formulary bills, HB 529 or HB 592, would be a huge step forward in combating opioids and some of the other abuses and excesses we see in workers’ compensation pharmacy costs in Louisiana. Let your voice be heard on these critical issues in Louisiana. Lawmakers need to know how employers, insurers, administrators and other stakeholders feel about these proposals. The session is just getting underway and there is no time like the present to share expertise to help educate legislators in Baton Rouge on the benefits all these bills could have in helping improve the system for all stakeholders by helping ensure injured workers receive safer, more efficacious and cost-effective care. 

Click on the bill number to see the complete text of the introduced legislation: HB192, HB529, or HB592.

For questions or additional information, please contact Brian Allen at Brian.Allen@optum.com or at 801-661-2922.





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