The Pennsylvania voted 34-16 to pass an amendment to the Workers’ Compensation Act that adds a “nationally recognized, evidence-based prescription drug formulary” for resolving issues regarding drugs prescribed for the treatment of work-related injuries. The amendment also addresses the certification required of a utilization review organization used in workers’ compensation cases.
Under this state Senate-approved amendment, solving issues related to drugs prescribed for work-related injuries would use a “nationally recognized, evidence-based prescription drug formulary.” The selection of the drug formulary would consider if the formulary focuses on medical treatment specific to workers’ compensation along with whether the formulary “includes measures to aid in management of opioid medications.”
Outside of a workers’ compensation judge’s request for a peer review opinion, the Pennsylvania Department of Labor and Industry can request a utilization review at random when questioning the “reasonableness or necessity” of a treatment by a health care provider.
The department, under this amendment, would approve utilization review organizations that it determines have gained certification or accreditation by a “nationally recognized organization” with certification standards deemed appropriate for resolving utilization issues for workers’ compensation programs.
The certification and accreditation process under this amended subclass couldn’t exceed $1.5 million annually to the department and would be transferred to the Workers’ Compensation Administration Fund.
An Oct. 11 memo issued by Sens. Donald C. White, Joseph B. Scarnati III and Mike Regan cited recently published articles that explored law firms that specialize in workers’ compensation and own pharmacies. The articles, according to the state senators who later drafted the amendment, point out “that arrangements such as these have led to increased prescriptions of opioids and expensive, unproven pain creams.”