As of February 3, 2020

California governor’s budget includes prescription drug cost reduction proposals
As part of his 2020/2021 budget proposals, California Governor Gavin Newsom is proposing several initiatives to reduce the cost of prescription drugs.

One option proposes to establish a single market for drug pricing within the state to enable all purchasers (Medi-Cal, private insurers, etc.) to combine their purchasing power. Under the proposal, drug manufacturers would be required to bid to sell their drugs at a uniform price in the California market. And the state would invoke a “most-favored-nation clause” requiring manufacturers to offer prices at or below the price offered to any other “state, nation, or global purchaser.”

Another proposal from the governor would have the state partner with one or more generic drug manufacturers to establish its own generic drug label. Bolstering this concept is recently filed Senate Bill 852 stating the legislature intends to introduce legislation requiring the state to manufacture generic prescription drugs in an attempt to control prescription drug costs.

Colorado workers’ comp stakeholder meetings
The Colorado Division of Workers’ Compensation is seeking input from stakeholders about current issues in workers’ compensation. Their 7th annual stakeholder meetings will also allow participants to weigh in on potential revisions for Rules 16 and 18, which address medical utilization standards and fee schedules. To view the meeting schedule, proposed agenda items and to RSVP, click here. Attendees can participate in person or via a remote webinar option. The first meeting is scheduled for March 26.

Kentucky amends proposed workers’ comp medical treatment guidelines after stakeholder input
After receiving several comments, the Kentucky Department of Workers’ Claims has amended its proposed medical treatment guidelines in the “statement of consideration.”

Notable amendments include:

• Adding clarity on how to handle treatment categories (recommended, conditionally recommended, not recommended) in the ODG treatment guidelines.
• Clarifying the tie-in to existing utilization review processes and timeframes.
• Removing a provision that would have required a short timeframe for a payer to notify the provider and injured person of a denial.

The proposed effective date has been delayed to September 1, 2020, rather than July 1, 2020, as originally proposed. The amended medical treatment guidelines are scheduled to be reviewed by the Administrative Regulation Review Subcommittee on February 10.

New Jersey ruling orders workers’ comp payment for medical marijuana; legislation follows
Reviewing a workers’ comp judge’s earlier decision, a New Jersey appeals court has ruled that reimbursement for medical marijuana treatment is required in a workers’ comp claim involving medical marijuana use for pain, in lieu of opioids. The decision came around the time related legislation attempted in the prior session was re-introduced — this bill requires both workers’ compensation and personal injury protection benefits to include coverage for costs associated with medical marijuana use, provided:

• The injured person is a qualified patient authorized for medical marijuana use, pursuant to the state medical marijuana law.
• At least one other medication or treatment has been attempted and found to be unsuccessful in treating the debilitating medical condition.

Oregon planning workers’ comp modernization program
The Oregon Workers’ Compensation Division is planning to modernize its business processes to improve efficiencies. Planned updates include certain outdated manual and paper-based processes and legacy applications requiring business process workarounds and sub-applications.

Division staff and contractors will reach out to representatives of insurers, employers, injured workers and others for input. The objective is to design system replacements or enhancements that truly meet the expressed needs, not the assumed needs, of the people and organizations that exchange information with the division. Companies can let the division know who they may contact within their organization by emailing WCD.Modernization@oregon.gov or contacting Fred Bruyns at 503-947-7717.