Bill and Title: SB 369 – Workers Compensation Drug Formulary
Author: Sen. Randy Head (R-Logansport)
Summary: Except during a medical emergency, prohibits workers’ compensation and occupational disease compensation reimbursement for drugs specified in the Official Disability Guidelines (ODG) Workers’ Compensation Drug Formulary Appendix A published by MCG Health as “N” drugs. Permits a prescribing physician to request to prescribe an “N” drug. Provides that, if the employer approves the request, the prescribing physician may prescribe the “N” drug. Provides that, if the employer does not approve the request, the employer shall: (1) shall send the request to a third party that is certified by the Utilization Review Accreditation Commission to make a determination concerning the request; and (2) notify the prescribing physician and the employee of the third party’s determination not more than five business days after receiving the request. Provides that, if the third party’s determination is to deny the request, the employer shall notify the prescribing physician and the employee, and the employee may apply to the worker’s compensation board for a final determination concerning the third party’s determination. Provides that, if the employer fails to notify the physician and the employee of the third party’s determination, the prescribing physician’s request is considered approved, and reimbursement of the “N” drug is authorized.
Chamber Position: Support
Status: Passed the House Employment, Labor and Pensions Committee; now on second reading and awaits amendment discussions on Monday.
Update/Chamber Action: In the committee hearing, the Chamber led testimony for the proponents – including adapting our comments to refute claims made by opponents. The history of drug formularies is quite extensive in the commercial health insurance markets, as well as Medicaid and Medicare. Recently, there has been a trend to see drug formularies created in worker’s comp.
Texas used ODG and has seen significant savings in the cost of prescriptions and reductions in the number of opioid prescriptions. While the American College of Occupational and Environmental Medicine or ACOEM was used in California to develop a drug formulary, California has some of the highest worker’s comp rates in the country. It is our hope to not mirror California.
Representative Chuck Mosely (D-Portage) questioned the Chamber’s support for using one vendor and our opinion of a study committee on the issue. The Chamber responded that we would agree to a two-year wait for existing claims similar to what Texas did. We testified we are confident in using the ODG system and see no need to take this to summer study committee.
The Insurance Institute of Indiana also testified in support and noted that the Indiana State Medical Association was on board with this proposal.
Resource: Mike Ripley at (317) 264-6883 or e-mail: [email protected]