The state senate recently passed a bill mandating a drug formulary for Workers’ Compensation. Although insurers are welcoming of the bill, it is being rigorously opposed by trial attorneys, who believe it is an attempt to curb utilization review organizations.
Formularies have been historically used by medical insurers to control prescription costs by listing the drugs that they will cover. Pennsylvania is the most recent state to adopt this strategy. According to the bill’s latest text, 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.”
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 requires utilization review organizations to be nationally accredited or certified.
In an interview published by Business Insider, AlpernSchubert P.C. attorney Larry Chaban asserted that the bill is an attempt to control the decisions of utilization review organizations through the cost of getting certified. Moreover, the bill does not address the issue of opioids, and it reduces physician choice.
Insurance trade associations, who stand to benefit from the bill, support it. They have stated that they believe it brings a consistent and high quality of medical care to injured workers. However, the Pennsylvania Association for Justice, a trial lawyer organization of which Mr. Chaban is a member, has offered amendments to the bill that would make it more beneficial to injured workers, which were rejected. The amendments would have limited the cost of compound creams to 10 percent over the actual cost to the pharmacy, and would have required doctors to check the opioid registry before writing prescriptions for opioids, among other changes. The bill will now go to the state House of Representatives.
If you have been injured in a workplace accident, you have rights. Contact us online or call 412-765-1888 today to schedule free case evaluation. The knowledgeable and highly skilled Pittsburgh Workers’ Compensation lawyers at AlpernSchubert P.C. serve clients throughout Western Pennsylvania, including those in Allegheny County, Lawrence County, Washington County and New Castle, Pennsylvania.