Drug Formulary Approved by the Senate

May 9, 2018

A Philadelphia newspaper recently reported on the ethically questionable alliances being formed between lawyers, doctors, and pharmacists. Workers’ compensation law firms have been opening their own pharmacies and referring their clients to those pharmacies to have their prescriptions filled. In return, doctors at these pharmacies would refer their patients to the law firm.

This type of arrangement is ripe for corruption. Doctors may prescribe patients expensive opioids and other types of medication just to earn a profit. It also presents a conflict of interest as most patients are not aware that their doctors and lawyers will profit from their prescriptions. To prevent such arrangements from being made, the Pennsylvania House recently passed a bill that would establish a drug formulary.

Pennsylvania Legislature Passes Drug Formulary Bill

Currently, injured workers seek advice from a medical professional following a work injury who then prescribes the patient with appropriate medications. The new bill would instead require formularies to allow only those prescriptions mandated by insurers, which may not be the same medications prescribed by the patient’s doctor.

In a Memorandum, the Pennsylvania legislature described the intended benefits of the bill. A drug formulary would be adopted by the Pennsylvania workers’ compensation program to reduce the over-prescription of opioid painkillers and eliminate payments for overpriced, unproven medications. The bill would also require standards to be established for Utilization Review Organizations (UROs) and Peer Review Organizations (PROs) to ensure that they meet the same certification requirements as other utilization review organizations.

Controversy Surrounding Drug Formularies

Supporters of the bill argue that drug formularies will reduce prescription drug costs, provide better care for patients, and assist with the opioid crisis. They also point to other states that have implemented drug formularies as evidence of its viability. Drug formularies have become standard in healthcare and the CEO of the Pennsylvania Chamber of Business and Industry says they have proven to be an effective tool in combating addiction among injured workers. For example, Ohio adopted a workers’ compensation formulary in 2011 and the number of opioid addictions among workers dropped 59 percent.

However, opponents of the bill caution that it only benefits the insurance companies. They purport that the bill jeopardizes medical treatment and makes it easier to deny coverage to workers, according to a statement by the Pennsylvania AFL-CIO President. Opponents also critique the bill for being too vague and for giving insurance company lobbyists too much control over the creation of the formulary’s rules.

It remains to be seen whether Governor Wolf will sign or veto the legislation. However, his spokesman stated that the governor believes injured workers’ access to treatment should not be hindered. He further hinted at the governor’s disapproval of the bill by stating that the governor believes the bill would negatively impact the quality of care for millions of workers, particularly high-risk workers such as law enforcement and laborers.

Philadelphia Workers’ Compensation Lawyers at Larry Pitt & Associates, P.C. Help Injured Workers Navigate the Workers’ Compensation System

If you suffered a work injury, you may be entitled to compensation under the Pennsylvania workers’ compensation system, including medical and wage-loss benefits. To arrange a free consultation with a Philadelphia workers’ compensation lawyer at Larry Pitt & Associates, P.C., call us at 1-888-PITT-LAW or complete our online contact form.

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