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To Be or Not to Be – the Fate of the Louisiana Workers’ Compensation Drug Formulary

Optum Workers' Comp
| May 18, 2017

The debate over a drug formulary for the Louisiana workers’ compensation system rages on in the halls of the capitol in Baton Rouge. In one of the latest turns, the Workforce Commission and the Office of Workers’ Compensation Administration made a joint public proclamation1 opposing drug formularies as “unproven” and “unnecessary”, suggesting instead that other proposed controls will reduce the prescribing of opioids. The proposed controls would cover all sectors of the healthcare system and are not specific to workers’ compensation. The controls include a recommended seven-day limit for initial opioid prescriptions and the mandatory review of the patient’s Schedule II medication history in the state’s prescription drug monitoring program. While we agree these controls will have an impact, we think it is important to engage every reasonable tool at our disposal to combat the current opioid epidemic. 

The Brandeis University Prescription Drug Monitoring Program Training and Technical Assistance Center has been tracking the impact of mandatory inquiries of prescription drug databases and released an updated briefing in May 20162.  In that report, Kentucky registered an 8.5% reduction in controlled substance prescriptions, Tennessee noted an 8% reduction in opioid prescriptions, New York saw a 9.5% drop in the prescriptions for opioids, and Ohio saw an 8.7% reduction in oxycodone and an 11.1% reduction in hydrocodone. Those are positive gains and demonstrate the value of requiring prescribers to consult the database before prescribing an opioid. 

Legislating a recommended time limit for an initial opioid prescription is a relatively recent concept and it is too early to have any substantive data on the impact of such laws. While most of the laws appear to be soft recommendations, none of the laws provide a workers’ compensation claims administrator a real opportunity to challenge the use of an opioid. Certainly, the laws have tremendous value in calling attention to the opioid crisis and by encouraging physicians to examine their prescribing practices and to look for non-opioid alternatives to treating pain. 

It is also important to examine the impact of the Texas formulary, another tool in the theater of battle against opioids. The statement released by the Louisiana Workforce Commission and the Office of Workers’ Compensation Administration stated, “The insurer is better off financially, but no one knows if the injured worker is enjoying a true level of better health and it seems no one cares.” This is an unfortunate statement demeaning good employers and those providing care in the Texas system and mischaracterizes why Texas adopted a drug formulary. We work closely with the policymakers in Texas and can unequivocally say that Commissioner Brannan and his staff are extremely vigilant in their dedication to ensuring quality care for injured workers in Texas. We provide services to a number of insurance carriers and claims administrators and all of them work hard to provide quality care to injured workers.  Texas recognized early the devastating impact that opioid dependence and addiction was having on its injured workers and was one of the first states to address the opioid crisis with the implementation of their closed formulary in 2011. Fortunately, Texas had good data on prescription patterns prior to implementation of their drug formulary and have carefully collected data since the implementation of their formulary allowing for some comprehensive comparative studies. In their July 20163 update on the impact of the closed formulary, Texas has sustained a 77% reduction in the number of “N” drugs being prescribed to injured workers. The “N” drug list contains a number of long-acting opioids, along with other medications. Interestingly, prescriptions for other medications reduced by over 10%. Perhaps the most telling indication of the impact on the quality of care for Texas injured workers is the reduction in disability time. Reports out of Texas indicate that since the implementation of the closed drug formulary they have seen a measurable reduction in the disability time for injured workers, which means that injured workers are getting better faster and returning to work and supporting their families more quickly. 

The use of a drug formulary and the deploying of other tools, like mandatory ​Prescription Drug Monitoring Program (PDMP) reporting and recommending time limits for opioids prescriptions, are not mutually exclusive. A workers’ compensation drug formulary is a valuable tool and is the only tool targeted specifically to dealing with the unique needs of an injured worker. HB592, sponsored by Rep. Talbot, will be debated on the Louisiana House floor this week.  We urge the House members to support the legislation. A responsible, work comp-focused drug formulary, is a proven solution that demonstrates quality and compassionate care by helping the injured worker avoid the adverse effects of long-term opioid use and accelerating their return to work.

[1] Pharmacy Formulary Facts, Louisiana Workforce Commission

[2] PDMP Center of Excellence PDMP prescriber use mandates: characteristics, current status and outcomes in selected states, May 2016

[3] Impact of the Texas Pharmacy Closed Formulary, July 2016

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