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Pennsylvania governor issues opioid prescribing guidelines for workers’ compensation providers

by | Jul 18, 2018

On July 16, 2018, Governor Wolf of Pennsylvania announced the introduction of opioid prescribing guidelines for workers’ compensation to help prescribing providers determine the effective and appropriate use of opioids. This activity comes on the heels of recent contentious political wrangling between the governor and the legislature on a drug formulary and opioid controls for workers’ compensation claims. No formal rule-making process occurred to develop these guidelines.

The Governor stated that members of his “Prescribing Guidelines Task Force” (membership includes various state agencies, representatives from medical associations, provider advocates and community members) worked hard in developing the new guidelines which, when added to existing opioid prescribing guidelines developed by the Department of Health, bring the total number of opioid guidelines to eleven.

In 2017, the Workers’ Compensation Research Institute (WCRI) found that in Pennsylvania, the percentage of injured workers who became long-term users of opioids ranked among the highest in the nation. As a response to these findings, the new guidelines include recommendations for treatment of acute, sub-acute and post-operative pain as well as treatment of chronic pain which are intended to:

  • Promote delivery of safe, quality healthcare to injured workers
  • Ensure patient pain relief and functional improvement
  • Be used in conjunction with other treatment guidelines, not in lieu of other recommended treatment
  • Prevent and reduce the number of complications caused by prescription medication, including addiction
  • Recommend opioid prescribing practices that promote functional restoration

The vast majority of the new workers’ compensation prescribing guidelines require ongoing interaction between prescriber and the injured worker and provide prescribers with a clear path to follow when making medical decisions on utilization of opioids in treating both acute and chronic pain. There are various requirements for both the injured worker and the prescriber throughout the treatment period for both acute and chronic pain.

Noteworthy under the treatment requirements for acute pain, the guidelines recommend initial prescriptions of opioids for acute pain should be limited to a 7-day supply. Under treatment requirements for chronic pain, the guidelines call for co-prescribing of Naloxone for certain specific claimants. The opioid prescribing guidelines are intended to supplement but not replace clinical judgment or use of other evidence-based guidelines.

A compilation of all of the opioid prescribing guidelines can be found on the Pennsylvania Department of Health website here.

We recommend payers discuss the new opioid prescribing guidelines with their pharmacy services provider to ensure their pharmacy processes work in conjunction with guidelines to maximize the effectiveness of limiting opioid utilization. All OWCA clients can discuss this new development and impact on their processes with their Clinical liaison. If you have questions regarding this or any other developing public policy issues, please contact our Government Affairs team at AskGovtAffairs@optum.com

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