The Pennsylvania House of Representatives may soon consider a bill that would restrict the ability of doctors to provide certain medications to patients who become injured at work.
The proposed law would create a “drug formulary” for prescription opioids for injured workers. In essence, injured workers would only have access to a limited set of prescription medications and treatments while receiving workers’ compensation. This bill is meant to reduce the over-prescription of opioid pain killers to these types of patients.
Proponents of the bill argue that drug formularies are more cost-effective than having individual doctors issue prescriptions according to what is in the best interests of their patients. However, the proposed bill remains controversial. Pennsylvania Governor Tom Wolfe is opposed to the bill in its current form, but it is too early to determine if the bill will receive the changes necessary to pass in both chambers and be signed into law.
Opioid bill, or boon to insurers?
The bill passed committee by only a small margin. Lawmakers questioned whether the bill would do anything to actually combat the opioid crisis in Pennsylvania. Minority Committee Chair Rep. John Galloway argued that the bill was not really an opioid bill, but a policy change masked as something to help stem the opioid epidemic in the state.
Critics of drug formularies argue that this bill would take away from the doctor-patient relationship. Instead of being able to prescribe what the doctor and patient believe is best, both must consider whether the right medication is on the drug formulary. Doctors who want to write a prescription that is not preapproved would have to state in writing why that particular drug is medically necessary for the patient, but an insurance company would still be able to appeal the doctor’s recommendation at its discretion.
Still a long way from the law
While the bill has made it out of committee, it still has a long way to go before it can become a law. This bill is another example of the complex and competing interests at play in every workers’ compensation claim. On one side, insurers and employers will do everything they can to manage costs. On the other, injured workers must fight to get the medical care they need to improve physically and mentally. Regardless of the outcome of this particular bill, these competing interests will remain significant in workers’ compensation claims in the future.